Early compliance with lung cancer lymph node standard 5.8: An analysis of 2022 and 2023 Commission on Cancer site reviews

Alison S Baskin; Elizabeth C Funk; Amanda B Francescatti; Brandy R Sinco; Bryan E Palis; Tina J Hieken; Matthew H G Katz; Judy C Boughey; Ronald J Weigel; Lesly A Dossett; Daniel J Boffa

doi:10.1016/j.jtcvs.2025.04.041

Early compliance with lung cancer lymph node standard 5.8: An analysis of 2022 and 2023 Commission on Cancer site reviews

J Thorac Cardiovasc Surg. 2025 May 3:S0022-5223(25)00340-X. doi: 10.1016/j.jtcvs.2025.04.041. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, University of California, San Francisco, San Francisco, Calif; Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Mich.
² Cancer Research Program, American College of Surgeons, Chicago, Ill.
³ Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Mich; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Mich.
⁴ Cancer Research Program, American College of Surgeons, Chicago, Ill; Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, Minn.
⁵ Cancer Research Program, American College of Surgeons, Chicago, Ill; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex.
⁶ Cancer Research Program, American College of Surgeons, Chicago, Ill; Department of Surgery, University of Iowa, Iowa City, Iowa.
⁷ Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Mich; Cancer Research Program, American College of Surgeons, Chicago, Ill; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Mich; Department of Surgery, Michigan Medicine, Ann Arbor, Mich.
⁸ Section of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn; Commission on Cancer, American College of Surgeons, Chicago, Ill. Electronic address: daniel.boffa@yale.edu.

PMID: 40324749
DOI: 10.1016/j.jtcvs.2025.04.041

Abstract

Objective: To address variability in nodal staging during curative-intent lung cancer resections, the Commission on Cancer implemented Standard 5.8 in 2021, requiring lymph nodes be sampled from ≥3 mediastinal stations and ≥1 hilar station and documented in a synoptic pathology report. We assessed compliance data from recent site reviews to evaluate the early implementation of Standard 5.8 through a federally funded collaborative.

Methods: Hospital compliance rates with Standard 5.8 were extracted from a repository of site reviewers' documentation of Commission on Cancer site visits performed during 2022 and 2023. Each review included up to 7 randomly selected pathology reports eligible for the standard. For a site to be compliant, 5 of 7 pathology reports reviewed in 2022 must have met Standard 5.8, which increased to 6 of 7 reports in 2023 and beyond.

Results: Overall, 652 site visits occurred in 2022 and 2023. Sites without eligible cases (n = 148 [23%]) were excluded. Among 504 eligible sites, 272 (54%) were found compliant, and 232 (46%) were found noncompliant. Of noncompliant sites, the median percentage of pathology reports meeting the standard was 29%. From 2022 to 2023, the median percentage of adherent pathology reports increased; however, overall compliance rates dipped in 2023 as the threshold needed for site compliance rose.

Conclusions: With almost half of Commission on Cancer-accredited sites noncompliant, there is a real opportunity to improve the quality of surgical lymph node evaluations. This aligns with growing efforts to support hospitals and surgeons with quality improvement tools and resources for Standard 5.8.

Keywords: Commission on Cancer; Operative Standard; accreditation; compliance; lung cancer; lymph node staging; quality improvement.