The Canada Lymph Node Score: A Feasibility Randomized Controlled Trial

Official Title

The Canada Lymph Node Sonographic Score as an Evaluation of Mediastinal Lymph Node Malignancy for Lung Cancer Patients: A Feasibility Randomized Controlled Trial


For patients diagnosed with early stage Non-Small Cell Lung Cancer (NSCLC) on preoperative computerized tomography (CT) and positron emission tomography (PET) scans, surgical resection is usually the preferred method of treatment. However, to be eligible for surgery, current guidelines require that the cancer has not spread to the lymph nodes in the chest cavity. To evaluate these lymph nodes, the standard of care is to undergo an endobronchial ultrasound (EBUS) procedure, where all the visible lymph nodes in the chest are biopsied (sampled) with a needle. Unfortunately, these biopsies are often inconclusive, especially in patients who have no evidence of lymph node spread on pre-operative imaging. Currently, the standard of care mandates that inconclusive biopsies should be repeated, either through another EBUS, or through more invasive surgery. Repeat inconclusive biopsies are oftentimes inconclusive as well; leading to a vicious cycle of inconclusive results, a delay in treatment, morbidity for the patient, and increased costs to the healthcare system. To circumvent this issue, the investigators have developed, validated and published a 4-point score, the Canada Lymph Node Score (CLNS), which uses four features observed on ultrasound during EBUS to predict whether the cancer has spread to the lymph nodes or not. Research has demonstrated that lymph nodes which appear benign on both CT and PET scan that also have a CLNS of ≤1/4 are almost certainly benign. As such, it is believed that these "triple negative nodes" do not require biopsy (or repeat biopsy). 

The investigators are challenging the current standard of care in lung cancer, which mandates that all the lymph nodes in the chest need to be biopsied (i.e. Systematic Sampling) before surgery, by proposing that triple negative lymph nodes can be omitted, and only those with cancer potential should be biopsied (i.e. Targeted Sampling).To prove this hypothesis, a randomized controlled trial comparing Systematic Sampling to Targeted Sampling is required. A feasibility trial is proposed to determine whether this large-scale randomized trial will be possible.

Trial Description

Primary Outcome:

  • Recruitment Rate
Secondary Outcome:
  • Prevalence of Each Possible CLNS
  • Procedure Length
  • Frequency of Biopsies
  • Number of Samples Obtained
  • Diagnostic Yield
  • Percent of Inconclusive Biopsies
  • Number of Repeated Biopsies

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Canadian Cancer Society

These resources are provided in partnership with the Canadian Cancer Society