Memphis Metropolitan Area Research Articles

Abstract C008: Exploring socioeconomic and racial influences on breast cancer comorbidity in the Memphis metropolitan area: A geospatial and machine learning analysis

Abstract C008: Exploring socioeconomic and racial influences on breast cancer comorbidity in the Memphis metropolitan area: A geospatial and machine learning analysis

Particulate matter exposure predicts residence in high-risk areas for community acquired pneumonia among hospitalized children.

Particulate matter exposure is a risk factor for lower respiratory tract infection in children. Here, we investigated the geospatial patterns of community-acquired pneumonia and the impact of PM2.5 (particulate matter with an aerodynamic diameter ≤2.5 µm) on geospatial variability of pneumonia in children. We performed a retrospective analysis of prospectively collected population-based surveillance study data of community-acquired pneumonia hospitalizations among children <18 years residing in the Memphis metropolitan area, who were enrolled in the Centers for Disease Control and Prevention sponsored Etiology of Pneumonia in the Community (EPIC) study from January 2010 to June 2012. The outcome measure, residence in high- and low-risk areas for community-acquired pneumonia, was determined by calculating pneumonia incidence rates and performing cluster analysis to identify areas with higher/lower than expected rates of community-acquired pneumonia for the population at risk. High PM2.5 was defined as exposure to PM2.5 concentrations greater than the mean value (>10.75 μg/m3), and low PM2.5 is defined as exposure to PM2.5 concentrations less than or equal to the mean value (≤10.75 μg/m3). We also assessed the effects of age, sex, race/ethnicity, history of wheezing, insurance type, tobacco smoke exposure, bacterial etiology, and viral etiology of infection. Of 810 (96.1%) subjects with radiographic community-acquired pneumonia, who resided in the Memphis metropolitan area and had addresses which were successfully geocoded (Supplementary Figure F2), 220 (27.2%) patients were identified to be from high- (n = 126) or low-risk (n = 94) community-acquired pneumonia areas. Community-acquired pneumonia in Memphis metropolitan area had a non-homogenous geospatial pattern. PM2.5 was associated with residence in high-risk areas for community-acquired pneumonia. In addition, children with private insurance and bacterial, as opposed to viral, etiology of infection had a decreased risk of residence in a high-risk area for community-acquired pneumonia. The results from this paper suggest that environmental exposures as well as social risk factors are associated with childhood pneumonia.

Food Deserts and Residential Real Estate Prices

The prevalence of neighborhoods with inadequate access to grocery stores, classified by the U.S. Department of Agriculture as “food deserts,” has become an issue of concern in recent years given that a growing body of research has shown that food deserts can have health-related consequences, such as heart disease, diabetes, and obesity. Despite this growing body of literature, no study to date has examined the consequences of food deserts on residential real estate prices. Using United States Census information from Shelby County, Tennessee, home to the Memphis metropolitan area, to determine whether access to a sufficient food source has an economic effect on housing prices and a dataset containing 3,298 residential real estate transactions, hedonic pricing models employing a large dataset of real estate transactions presented below in this study suggest that residential real estate prices are about 4% to 6% lower for houses located in food deserts than for their counterparts with adequate access to grocery stores.

Insignificant Impact of the “Stay-At-Home” Order on Ambient Air Quality in the Memphis Metropolitan Area, U.S.A.

The lockdowns due to the COVID-19 pandemic have been reported to reduce ambient air pollution in many cities globally. This study aims to examine whether air pollution dropped in Memphis, a typical U.S. metropolitan city and transportation hub, during the lockdown from 25 March to 4 May, 2020. Daily air pollution data measured at five representative monitoring stations in the Memphis Metropolitan Area were downloaded from the U.S. Environmental Protection Agency’s Air Quality System. The mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone during the lockdown were compared with the baseline concentrations measured during the same periods in 2017–2019 using linear regression models. The average vehicle miles traveled (VMT) reduced by 57% in this region during the lockdown compared to that during 1–24 March, 2020. The mean (± standard deviation) concentrations of PM2.5, NO2, and ozone were 7.5 ± 2.6 μg/m3, 16.5 ± 9.4 ppb, and 44.5 ± 8.4 ppb, respectively, during the lockdown. They did not statistically differ from the baseline concentrations, nor were they lower than the mean concentrations in the prior month (25 February–24 March, 2020), after accounting for meteorological conditions. The lack of effect could be explained by the small contribution of traffic emissions to air pollution. The results suggest that the “stay-at-home” order had an insignificant impact on reducing air pollution in Memphis.

Analysis of Commuting Distances of Low-Income Workers in Memphis Metropolitan Area, TN

The paper tests whether low-income workers suffer a greater commuting cost burden compared with a typical commuter within the context of decreasing economic opportunity. The paper adds to the spatial mismatch research by studying the metropolitan area in the U.S. South, which experienced “some of the largest decreases” in job proximity in 2012. Memphis, Tennessee, saw the disproportionately steep declines in the average employment opportunities within a typical commute distance experienced by low-income and minority residents. The paper first delineates low-income neighborhoods across the study area, then identifies commuting patterns within the three-state study area including the greater Memphis, and lastly, it compares average commute lengths by a typical and a low-income commuter, as well as the shares of resident workers with a long commute by earning category. The paper offers insight into the ways in which the changes in spatial location of employment and population within the metropolitan area may impact commuting distance for disadvantaged low-income travelers. We show low-income workers commute statistically significantly shorter distances to their places of work compared with a typical commuter. Our other results find that disadvantaged workers in Shelby County, TN, are disproportionately concentrated in lower-wage industries, such as hospitality and retail service industries, compared to overall workers. Finally, a significantly greater proportion of disadvantaged workers travel long distances of over 50 miles compared with higher-earning workers, indicating the disparity in commuting patterns between a typical resident and a low-income worker.

Attenuation of Lg waves in the New Madrid seismic zone of the central United States using the coda normalization method

Unique properties of coda waves are employed to evaluate the frequency dependent quality factor of Lg waves using the coda normalization method in the New Madrid seismic zone of the central United States. Instrument and site responses are eliminated and source functions are isolated to construct the inversion problem. For this purpose, we used 121 seismograms from 37 events with moment magnitudes, M, ranging from 2.5 to 5.2 and hypocentral distances from 120 to 440km recorded by 11 broadband stations.A singular value decomposition (SVD) algorithm is used to extract Q values from the data, while the geometric spreading exponent is assumed to be a constant. Inversion results are then fitted with a power law equation from 3 to 12Hz to derive the frequency dependent quality factor function. The final results of the analysis are QVLg (f)=(410±38) f0.49±0.05 for the vertical component and QHLg (f)=(390±26) f0.56±0.04 for the horizontal component, where the term after ± sign represents one standard error. For stations within the Mississippi embayment with an average sediment depth of 1 km around the Memphis metropolitan area, estimation of quality factor using the coda normalization method is not well-constrained at low frequencies (f<3Hz). There may be several reasons contributing to this issue, such as low frequency surface wave contamination, site effects, or even a change in coda wave scattering regime which can exacerbate the scatter of the data.

Spatiotemporal patterns of childhood asthma hospitalization and utilization in Memphis Metropolitan Area from 2005 to 2015

ABSTRACTObjective: To identify the key risk factors and explain the spatiotemporal patterns of childhood asthma in the Memphis metropolitan area (MMA) over an 11-year period (2005–2015). We hypothesize that in the MMA region this burden is more prevalent among urban children living south, downtown, and north of Memphis than in other areas. Methods: We used a large-scale longitudinal electronic health record database from an integrated healthcare system, Geographic information systems (GIS), and statistical and space-time models to study the spatiotemporal distributions of childhood asthma at census tract level. Results: We found statistically significant spatiotemporal clusters of childhood asthma in the south, west, and north of Memphis city after adjusting for key covariates. The results further show a significant increase in temporal gradient in frequency of emergency department (ED) visits and inpatient hospitalizations from 2009 to 2013, and an upward trajectory from 4 per 1,000 children in 2005 to 16 per 1,000 children in 2015. The multivariate logistic regression identified age, race, insurance, admit source, encounter type, and frequency of visits as significant risk factors for childhood asthma (p < 0.05). We observed a greater asthma burden and healthcare utilization for African American (AA) patients living in a high-risk area than those living in a low-risk area in comparison to the white patients: AA vs. white [odds ratio (OR) = 3.03, 95% confidence interval (CI): 2.75–3.34]; and Hispanic vs. white (OR = 1.62, 95% CI: 1.21–2.17). Conclusions: These findings provide a strong basis for developing geographically tailored population health strategies at the neighborhood level for young children with chronic respiratory conditions.

Application of Environmental Tracers in the Memphis Aquifer and Implication for Sustainability of Groundwater Resources in the Memphis Metropolitan Area, Tennessee

AbstractFourteen years of results from environmental tracer sampling for 3H, He isotopes, noble gases, and SF6 in production wells screened in the Memphis aquifer in Memphis, Tennessee, are presented and used to determine the age and mass proportion of modern water (&lt;60 years old) pumped from this regionally important public supply aquifer. The results indicate persistent presence of modern water in water pumped from one or more production wells in most of the well fields sampled. The percentage of modern water is quantified by three methods: tritium‐loading history, inverse geochemical modeling, and lumped parameter modeling. The mixing percentages and ages determined from each technique are generally in agreement, but also emphasize the unique information provided by each tracer and associated modeling approaches. The implications of the tracer data for sustainability and vulnerability are also considered, especially in regard to potential water quality threats to the water supply in the Memphis, Tennessee, metropolitan area.

Characterization of methicillin-resistant Staphylococcus aureus isolates from fitness centers in the Memphis metropolitan area, Tennessee.

Indoor skin-contact surfaces of public fitness centers may serve as reservoirs of potential human transmission of methicillin-resistant Staphylococcus aureus (MRSA). We found a high prevalence of multidrug-resistant (MDR) MRSA of clonal complex 59 lineage harboring a variety of extracellular toxin genes from surface swab samples collected from inanimate surfaces of fitness centers in the Memphis metropolitan area, Tennessee. Our findings underscore the role of inanimate surfaces as potential sources of transmission of MDR MRSA strains with considerable genetic diversity.

Ground‐Motion Simulations of 1811–1812 New Madrid Earthquakes, Central United States

We performed a suite of numerical simulations based on the 1811–1812 New Madrid seismic zone (NMSZ) earthquakes, which demonstrate the importance of 3D geologic structure and rupture directivity on the ground‐motion response throughout a broad region of the central United States (CUS) for these events. Our simulation set consists of 20 hypothetical earthquakes located along two faults associated with the current seismicity trends in the NMSZ. The hypothetical scenarios range in magnitude from M 7.0 to 7.7 and consider various epicenters, slip distributions, and rupture characterization approaches. The low‐frequency component of our simulations was computed deterministically up to a frequency of 1 Hz using a regional 3D seismic velocity model and was combined with higher‐frequency motions calculated for a 1D medium to generate broadband synthetics (0–40 Hz in some cases). For strike‐slip earthquakes located on the southwest–northeast‐striking NMSZ axial arm of seismicity, our simulations show 2–10 s period energy channeling along the trend of the Reelfoot rift and focusing strong shaking northeast toward Paducah, Kentucky, and Evansville, Indiana, and southwest toward Little Rock, Arkansas. These waveguide effects are further accentuated by rupture directivity such that an event with a western epicenter creates strong amplification toward the northeast, whereas an eastern epicenter creates strong amplification toward the southwest. These effects are not as prevalent for simulations on the reverse‐mechanism Reelfoot fault, and large peak ground velocities (>40 cm/s) are typically confined to the near‐source region along the up‐dip projection of the fault. Nonetheless, these basin response and rupture directivity effects have a significant impact on the pattern and level of the estimated intensities, which leads to additional uncertainty not previously considered in magnitude estimates of the 1811–1812 sequence based only on historical reports. The region covered by our simulation domain encompasses a large portion of the CUS centered on the NMSZ, including several major metropolitan areas. Based on our simulations, more than eight million people living and working near the NMSZ would experience potentially damaging ground motion and modified Mercalli intensities ranging from VI to VIII if a repeat of the 1811–1812 earthquakes occurred today. Moreover, the duration of strong ground shaking in the greater Memphis metropolitan area could last from 30 to more than 60 s, depending on the magnitude and epicenter. Online Material: Tables of 1D velocity models used to generate the high‐frequency synthetics, and figures of source models and peak ground motion synthetics.

Health Information Exchange Reduces Repeated Diagnostic Imaging for Back Pain

This study seeks to determine whether health information exchange reduces repeated diagnostic imaging and related costs in emergency back pain evaluation. This was a longitudinal data analysis of health information exchange patient-visit data. All repeated emergency department (ED) patient visits for back pain with previous ED diagnostic imaging to a Memphis metropolitan area ED between August 1, 2007, and July 31, 2009, were included. Use of a regional health information exchange by ED personnel to access the patient's record during the emergency visit was the primary independent variable. Main outcomes included repeated lumbar or thoracic diagnostic imaging (radiograph, computed tomography [CT], or magnetic resonance imaging [MRI]) and total patient-visit estimated cost. One hundred seventy-nine (22.4%) of the 800 qualifying repeated back pain visits resulted in repeated diagnostic imaging (radiograph 84.9%, CT 6.1%, and MRI 9.5%). Health information exchange use in the study population was low, at 12.5%, and health care providers as opposed to administrative/nursing staff accounted for 80% of the total health information exchange use. Health information exchange use by any ED personnel was associated with reduced repeated diagnostic imaging (odds ratio 0.36; 95% confidence interval 0.18 to 0.71), as was physician or nurse practitioner health information exchange use (odds ratio 0.47; 95% confidence interval 0.23 to 0.96). No cost savings were associated with health information exchange use because of increased CT imaging when health care providers used health information exchange. Health information exchange use is associated with 64% lower odds of repeated diagnostic imaging in the emergency evaluation of back pain. Health information exchange effect on estimated costs was negligible. More studies are needed to evaluate specific strategies to increase health information exchange use and further decrease potentially unnecessary diagnostic imaging and associated costs of care.

Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department?

Health information exchange (HIE) is advocated as an approach to reduce unnecessary testing and improve quality of emergency department (ED) care, but little evidence supports its use. Headache is a specific condition for which HIE has theoretical benefits. To determine whether health information exchange (HIE) reduces potentially unnecessary neuroimaging, increases adherence with evidence-based guidelines, and decreases costs in the emergency department (ED) evaluation of headache. Longitudinal data analysis All repeat patient-visits (N = 2,102) by all 1,252 adults presenting with headache to a Memphis metropolitan area ED two or more times between August 1, 2007 and July 31, 2009. Use of a regional HIE connecting the 15 major adult hospitals and two regional clinic systems by authorized ED personnel to access the patient's record during the time period in which the patient was being seen in the ED. Diagnostic neuroimaging (CT, CT angiography, MRI or MRI angiography), evidence-based guideline adherence, and total patient-visit estimated cost. HIE data were accessed for 21.8 % of ED patient-visits for headache. 69.8 % received neuroimaging. HIE was associated with decreased odds of diagnostic neuroimaging (odds ratio [OR] 0.38, confidence interval [CI] 0.29-0.50) and increased adherence with evidence-based guidelines (OR 1.33, CI 1.02-1.73). Administrative/nursing staff HIE use (OR 0.24, CI 0.17-0.34) was also associated with decreased neuroimaging after adjustment for confounding factors. Overall HIE use was not associated with significant changes in costs. HIE is associated with decreased diagnostic imaging and increased evidence-based guideline adherence in the emergency evaluation of headache, but was not associated with improvements in overall costs. Controlled trials are needed to test whether specific HIE enhancements to increase HIE use can further reduce potentially unnecessary diagnostic imaging and improve adherence with guidelines while decreasing costs of care.

Resolving the source and mixing proportions of modern leakage to the Memphis aquifer in a municipal well field using geochemical and 3H/3He data, Memphis, Tennessee, USA

The Memphis aquifer in southwestern Tennessee is a confined to semi-confined unconsolidated sand aquifer and is the primary municipal water source for the Memphis metropolitan area. Leakage of modern water from shallow unconfined aquifers through the upper Claiborne confining unit locally degrades water quality in the Memphis aquifer and makes the aquifer more vulnerable to contamination. Major solute chemistry, tritium, and 3H/3He data were used to investigate the source and mixing proportions of modern water in the Memphis aquifer in the Davis well field, Memphis, Tennessee. Water quality in several production wells in the Davis well field has declined over the past 30 years, mainly through increased total dissolved solids, iron, alkalinity, and hardness. Trends in chemical data, tritium, and other hydrogeologic data support a source for the leakage from the Mississippi River Valley Alluvial aquifer. Mixing proportions of alluvial water in production well water obtained by inverse chemical modeling with PHREEQCi range from 7 to 45%. For two of the production wells, MLGW 414 and 432, 3H/3He data yield mixing ratios similar to those obtained from PHREEQCi in three of four cases; the dissimilar ratio is likely due to a poor solution from the PHREEQCi inverse modeling. Modeling of the age distribution obtained from MLGW 414 and 432 using an exponential-piston flow model (EPM) with an inverse solution computer code yielded mixed results. The EPM solution obtained for MLGW 414 converged with difficulty only for a 5-year transit time in the shallow aquifer and is consistent with a source from the Mississippi River Valley Alluvial aquifer; however, the modeled age of the water is greater than that observed. In comparison, the EPM solution for MLGW 432 converged for the 5- and 7-year transit periods in the shallow aquifer and yielded model ages consistent with observed 3H/3He ages; however, the extent of the maximum radii for infiltration source is not consistent with a Mississippi River Valley Alluvial aquifer source. Other potential sources for leakage to MLGW 432 include water from the Fluvial-terrace aquifer migrating along a fault east of the well field or infiltration of water from a lake south of the well field.

Pathologic Lymph Node Staging Practice and Stage-Predicted Survival After Resection of Lung Cancer

Lymph node status is the most important prognostic factor in resectable nonsmall-cell lung cancer (NSCLC). We examined the relationship between the pattern of lymph node examination (including the number and anatomic location of resected lymph nodes), pathologic nodal stage, and survival after NSCLC resection. Retrospective review of all NSCLC resections in the Memphis Metropolitan Area from January 1, 2004, to December 31, 2007. In 656 resections, the number of lymph nodes examined differed significantly between patients grouped by pathologic nodal stage (p<0.0001) and extent of resection (p<0.001). Thirty-seven percent of "mediastinal node-negative" patients had no mediastinal lymph nodes examined. Patients with pN1 and no mediastinal lymph node examination had better [corrected] survival than patients with mediastinal lymph node examination (p < 0.02) . Approximately 10% of patients with pN0 and pN2 disease had no hilar/intrapulmonary lymph nodes examined. Suboptimal lymph node staging was prevalent in this cohort. Large proportions of pN1 and pN0 patients were probably understaged. In patients with pathologic positive pulmonary/hilar lymph nodes, mediastinal lymph node examination was associated with poorer survival [corrected]. Interventions are needed to improve lymph node staging of NSCLC.

Invited Commentary

This retrospective review by Osarogiagbon and colleagues [1] of all non-small cell lung cancer resections, performed in the Memphis Metropolitan area during a 4-year time span, addresses an important issue affecting patients with resectable lung cancer. Adequacy of lymph node staging is crucial, because it provides the most important prognostic information in patients with loco-regional non-small cell lung cancer. This is typically accomplished by a combination of imaging and surgical sampling.

A comparison of surgical resection for distal esophageal, gastroesophageal junction, and proximal gastric cancers in the Memphis metropolitan area (MMA).

147 Background: The incidence of distal esophageal (DE) and gastroesophageal junction (GEJ) tumors has increased rapidly in recent decades. They are often included in gastric cancer trials. The 7th AJCC staging has reclassified tumors of the DE, GEJ, and proximal stomach (PS) as esophageal cancers. We compared the historical management of these tumors in our community. Methods: Review of all curative-intent DE, GEJ, and PS cancer resections at two healthcare institutions in the MMA from 1999-2008. Results: Seventy patients were identified (Table). Males predominated. The histology was adenocarcinoma in 48% of DE, 91% of GEJ, and 100% of PS cancers. Preoperative endoscopic ultrasound (EUS) was performed in 10% of DE, 6% of GEJ, and 7% of PS patients. Neoadjuvant therapy was given to 29% of DE, 35% of GEJ and 0% of PS patients. R0 resection rates were similiar. Fewer DE and GEJ patients had up to 15 lymph nodes removed, yet lymph node metastasis was identified in 52% and 35% respectively, compared to 20% of PS patients (Table). Five-year survival rates were numerically higher in the DE and GEJ patients. Conclusions: We identified differences in DE, GEJ, and PS tumors in a community setting with respect to preoperative management and lymph node sampling. Reclassification of DE, GEJ, and PS tumors by the AJCC suggests these groups now be treated uniformly as esophageal cancers, a shift from previous management as gastric cancers. Further, prospective evaluation is needed to assess the patterns of management and outcomes in tumors of the DE, GEJ and PS. [Table: see text] No significant financial relationships to disclose.

Pattern of gastric cancer resection in the Memphis metropolitan area (MMA).

e14633 Background: Quality of cancer surgery impacts patient outcomes. We evaluated the pattern and quality of gastric cancer resections and correlated them with postoperative and long term survival in the MMA. Methods: Institutional review of all curative-intent gastric cancer resections from 1999-2008 excluding those who received preoperative therapy. Good quality resection (GQR) was defined as R0 with ≥ 15 lymph nodes (LN) examined. Log rank test for survival comparisons, Wilcoxon Mann Whitney for comparison between medians and proportional hazard models were employed. Results: Table: Cohort characteristics (N=112). GQR rate: 26%. Only 6% of patients had preoperative endoscopic ultrasound (EUS) or laparoscopic staging. Unexpected metastatic disease was discovered intraoperatively in 25% of the patients. R-status (p< 0.001), but not number of LN examined, correlated with survival. Tumor stage independently predicted survival on univariate analysis, while GQR, age, and number of comorbidities did not. Conclusions: R0 resection was associated with better survival in our MMA gastric resection cohort. The proportion of patients who had ≥ 15 LN examined was low. Increased utilization of preoperative staging modalities like EUS and laparoscopy, and emphasis on more thorough pathological examination of resection specimens can improve GQR rates. (%) P value Median age 66 (25-93) Sex Female 43 Male 57 Race Black 63 White 30 Other 7 Stage I 24 II 22 III 30 IV 22 Preoperative staging CT 71 EUS 3 Laparoscopy 3 Not reported 23 Gastrectomy Proximal 5 Distal 66 Total 28 R status R0 72 R1/R2 28 Median margin distance (mm) 10 (0-340) LN status Nx 4 N0 29 N1-3 66 Median LN examined Overall 14 (0-55) LN-negative patients 9 (1-43) p < 0.01 LN-positive patients 15 (0-55) # LN examined 0 5 < 15 54 ≥15 41 GQR p = 0.61 Overall 26 Stage I 20 Stage II 30 Stage III 28 Stage IV 25 60-day postoperative survival rate (%) 93 5-year survival rates (%) Overall 44 Stage p <0.01 I 74 II 35 III 39 IV 21 R status p < 0.001 R0 55 R1/R2 17 LN examined p = 0.61 < 15 49 ≥ 15 38 GQR p = 0.51 Yes 42 No 51 No significant financial relationships to disclose.

Surgeon-determined variability in quality of surgical resection of lung cancer.

7068 Background: Surgical resection is the main curative modality for patients with non-small cell lung cancer (NSCLC). Curative intent requires attainment of certain quality measures, including R0 resection, examination of hilar/pulmonary and mediastinal lymph nodes. Pneumonectomy and wedge resections may be associated with increased morbidity or suboptimal oncologic outcomes. We have previously demonstrated disparity in attainment of good quality resection (GQR) criteria in a large community cohort. We hypothesized that individual surgeons' practice may be the major determinant of attainment of GQR and sought to examine the extent of variability in surgical practice. Methods: All curative-intent resections for NSCLC in the Memphis Metropolitan Area from 1/1/04 to 12/31/08 were reviewed for quality measures and attainment of GQR by NCCN and RADIANT trial criteria. Surgeons were grouped by rate of failure to attain GQR criteria and the number of patients at risk was stratified by surgeon group. Results: 746 surgeries performed by 21 board-certified cardiothoracic or general thoracic surgeons were included. Performance is demonstrated (Table). Seven surgeons failed to meet NCCN criteria and 5 surgeons failed to meet RADIANT criteria in 100% of cases, affecting 168 and 134 patients. Conclusions: There is a wide amplitude of variability in performance of GQR by board-certified surgeons in this community-based cohort. In an era emphasizing quality of care and potential pay for performance there needs to be improvement in the characteristics of surgical resection in NSCLC. Rate (%) Surgeons N = 21 Patients N = 746 Resection with positive margins <5 10 233 5-10 8 458 >10 3 55 Resection without mediastinal lymph nodes <10 2 11 10-50 12 535 >50 7 200 Resection without any lymph nodes <10 8 266 10-20 10 455 >20 3 25 Pneumonectomy rate <5 7 194 5-15 7 389 >15 7 163 Wedge resection rate <5 5 102 5-15 11 493 >15 5 151 Failure to meet NCCN criteria <80 2 72 80-99 12 506 100 7 168 Failure to meet RADIANT criteria <80 11 432 80-99 5 180 100 5 134 No significant financial relationships to disclose.

Accuracy and comprehensiveness of pathology reportage after lung cancer resection

6523 Background: Decisions about prognosis, adjuvant chemo/radiation therapy and clinical trial eligibility require careful examination of the surgical resection specimen. In January 2004, the College of American Pathologists (CAP) and the American College of Surgeons Committee on Cancer mandated reportage of specific items after resection of lung cancer. The extent of compliance is unknown. Methods: We examined final pathology reports for all lung cancer resections in the Memphis Metropolitan Area from January 2004 to December 2007. End-points were the percentage of reports with each CAP item and the 6 most vital determinants of post-operative management and accuracy of TNM staging. Chi-square test was used for year to year comparisons. Results: Table 1 shows frequency of reportage of CAP items. Of those with reported pT stage, it was accurate in 242 of 263 (92.02%) identified as T1; 193 of 208 (92.79%) T2; 21 of 24 (87.5%) T3; 11 of 11 (100%) T4. The most common T-staging error, understaging of satellite nodules (T4), occurred in 12 of 21 (57%) mis-staged as T1, 11 of 15 (73%) T2, 3 of 3 (100%) T3. Overall, 62.6% of reports accurately identified pT-stage. Of those with reported pN-stage, 351 of 352 (99.7%) accurately identified N0; 69 of 81 (85.2%) accurately identified N1, 12 of 81 (14.81%) N1 designations were actually N2; 27 of 27 (100%) N2 designations were accurate; 31 of 34 (91.2%) identified as Nx (no lymph nodes in the specimen) were accurate, 3 (8.8%) were truly N0. Overall, 64.08% of reports accurately identified pN-stage. 4 of 503 identified as pMx (0.8%) had pM1. There was no change in proportion of incomplete and/or inaccurate pathology reports over the 4 years of analysis. Conclusions: Pathology evaluation of lung cancer resection specimens is frequently incomplete or inaccurate, potentially impairing clinical decision-making. Satellite nodules are often understaged. Simple corrective interventions such as enforcement of mandatory institutional utilization of the CAP checklist and AJCC staging manual need to be investigated. [Table: see text] [Table: see text]

Quality of surgical resection for non-small cell lung cancer (NSCLC) in a U.S. metropolitan area

7512 Background: Curative treatment of early stage NSCLC requires good quality oncologic resection (GQR). For GQR, the National Comprehensive Cancer Network (NCCN) requires a minimum of segmentectomy, negative margins, lymph node (LN) sampling from stations 10–14 (level-1) and &gt;2 mediastinal (level-2) stations. We reviewed details of consecutive resections for NSCLC to determine the proportion that met NCCN GQR criteria and the proportion who would have met eligibility for the RADIANT trial which requires &gt;1 level-2 stations. Methods: Retrospective review of medical records of all patients who underwent curative- intent resection for NSCLC in the Memphis Metropolitan Area from 1/1/2004 to 12/31/2007. Resections for benign and metastatic disease were excluded. Death information was obtained from a national death index search. Categorical variables were compared by chi-square test or Fisher's exact test, survival curves by log-rank test. Results: 746 patients were eligible (Table). Median age was 67.7 (range, 36.5 - 89.4). 61/746 (8.2%) met NCCN GQR criteria. Black patients were more likely than whites to have GQR (P=0.022). No other patient demographic factor was associated with GQR. Three year survival was 72% in those with GQR versus 63% in those without GQR (P=0.50). There was a difference in achievement of GQR between the 3 major institutions where surgery was done (P=0.001) although it was low across the board. 77.9% of patients would have been disqualified from the RADIANT trial. Conclusions: Majority of surgical resections for NSCLC did not achieve GQR standards per RADIANT and NCCN. The greatest deficit is in surgical sampling of level-2 LNs, but evaluation of level-1 LNs is also frequently sub-optimal. Intervention is needed to improve current surgical and pathology practices in collection and examination of surgical specimens in order to achieve minimum standards for accurate staging, prognostication, determination of candidacy for post-operative adjuvant therapy, and eligibility for clinical trials. [Table: see text] [Table: see text]