Our goal is to reduce diagnostic and treatment errors, improve survival, and increase the value of care for lung cancer patients by improving our ability to select patients who benefit from a lymph node biopsy prior to starting treatment. The ICONS study determines the effectiveness of guideline recommended selection criteria for a pretreatment lymph node biopsy, and it tests whether a novel approach to selecting patients for lymph node biopsy is equivalent to guideline recommended strategy in terms of survival but superior in terms of lower biopsy-related severe adverse events and health expenditures. Findings from this study will lead to: 1) developing and testing implementation strategies designed to increase guideline-concordant lymph node evaluation, 2) alternative guideline recommendations for lymph node evaluation, and/or 3) justifying trials comparing outcomes between different lymph node evaluation strategies.

Two clinical sites are contributing data to the ICONS study: Kaiser Permanente Northern California (Site PI: Lori Sakoda, PhD, MPH) and Marshfield Clinical Research Institute (Site PI: Robert Greenlee, PhD, MPH). The ICONS study is supported by the National Cancer Institute of the National Institutes of Health under award number R01CA258352 (PI: Farhood Farjah, MD, MPH).