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Romano G, Zirafa CC, Calabrò F, Alì G, Manca G, De Liperi A, Proietti A, Manfredini B, Di Stefano I, Marciano A, Davini F, Volterrani D, Melfi F. Sentinel Lymph Node Mapping in Lung Cancer: A Pilot Study for the Detection of Micrometastases in Stage I Non-Small Cell Lung Cancer. Tomography 2024; 10:761-772. [PMID: 38787018 PMCID: PMC11125324 DOI: 10.3390/tomography10050058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Lymphadenectomy represents a fundamental step in the staging and treatment of non-small cell lung cancer (NSCLC). To date, the extension of lymphadenectomy in early-stage NSCLC is a debated topic due to its possible complications. The detection of sentinel lymph nodes (SLNs) is a strategy that can improve the selection of patients in which a more extended lymphadenectomy is necessary. This pilot study aimed to refine lymph nodal staging in early-stage NSCLC patients who underwent robotic lung resection through the application of innovative intraoperative sentinel lymph node (SLN) identification and the pathological evaluation using one-step nucleic acid amplification (OSNA). Clinical N0 NSCLC patients planning to undergo robotic lung resection were selected. The day before surgery, all patients underwent radionuclide computed tomography (CT)-guided marking of the primary lung lesion and subsequently Single Photon Emission Computed Tomography (SPECT) to identify tracer migration and, consequently, the area with higher radioactivity. On the day of surgery, the lymph nodal radioactivity was detected intraoperatively using a gamma camera. SLN was defined as the lymph node with the highest numerical value of radioactivity. The OSNA amplification, detecting the mRNA of CK19, was used for the detection of nodal metastases in the lymph nodes, including SLN. From March to July 2021, a total of 8 patients (3 female; 5 male), with a mean age of 66 years (range 48-77), were enrolled in the study. No complications relating to the CT-guided marking or preoperative SPECT were found. An average of 5.3 lymph nodal stations were examined (range 2-8). N2 positivity was found in 3 out of 8 patients (37.5%). Consequently, pathological examination of lymph nodes with OSNA resulted in three upstages from the clinical IB stage to pathological IIIA stage. Moreover, in 1 patient (18%) with nodal upstaging, a positive node was intraoperatively identified as SLN. Comparing this protocol to the usual practice, no difference was found in terms of the operating time, conversion rate, and complication rate. Our preliminary experience suggests that sentinel lymph node detection, in association with the accurate pathological staging of cN0 patients achieved using OSNA, is safe and effective in the identification of metastasis, which is usually undetected by standard diagnostic methods.
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Affiliation(s)
- Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (F.C.); (B.M.); (F.D.); (F.M.)
| | - Carmelina Cristina Zirafa
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (F.C.); (B.M.); (F.D.); (F.M.)
| | - Fabrizia Calabrò
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (F.C.); (B.M.); (F.D.); (F.M.)
| | - Greta Alì
- Pathological Anatomy, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.A.); (A.P.); (I.D.S.)
| | - Gianpiero Manca
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, 56124 Pisa, Italy; (G.M.); (A.M.); (D.V.)
| | - Annalisa De Liperi
- 2nd Radiology Unit, Department of Diagnostic Imaging, University Hospital of Pisa, 56124 Pisa, Italy;
| | - Agnese Proietti
- Pathological Anatomy, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.A.); (A.P.); (I.D.S.)
| | - Beatrice Manfredini
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (F.C.); (B.M.); (F.D.); (F.M.)
| | - Iosè Di Stefano
- Pathological Anatomy, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (G.A.); (A.P.); (I.D.S.)
| | - Andrea Marciano
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, 56124 Pisa, Italy; (G.M.); (A.M.); (D.V.)
| | - Federico Davini
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (F.C.); (B.M.); (F.D.); (F.M.)
| | - Duccio Volterrani
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, 56124 Pisa, Italy; (G.M.); (A.M.); (D.V.)
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, 56124 Pisa, Italy; (G.R.); (F.C.); (B.M.); (F.D.); (F.M.)
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Nardini M, Bilancia R, Paul I, Jayakumar S, Papoulidis P, ElSaegh M, Hartley R, Richardson M, Misra P, Migliore M, Dunning J. 99mTechnetium and methylene blue guided pulmonary nodules resections: preliminary British experience. J Thorac Dis 2018; 10:1015-1021. [PMID: 29607175 DOI: 10.21037/jtd.2018.01.143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Subcentimetre pulmonary nodules can be challenging to locate either during video-assisted thoracoscopic surgery (VATS) or by open techniques. In an era of increasing computed tomography scan availability the number of nodules that are identified that are suspicious for malignancy is rising, and thoracic surgeons require a reliable method to locate these nodules intraoperatively. Methods Our aim was to evaluate, for the first time in the UK, resection of pulmonary nodules using radioactive dye labelling. Local research ethics approval was obtained and the study was submitted to the Integrated Research Application System (IRAS). All data were prospectively collected in our dedicated thoracic surgical database and analyzed at the conclusion of the study. This represents a consecutive series of patients, from January 2016 and until April 2017, who underwent this procedure at our institution: James Cook University Hospital, Middlesbrough, United Kingdom. The primary outcome measured was successful resection rate of the target nodules. Results Twenty-three patients underwent radiolabeled excision of pulmonary nodules, their average age was 61 years (range, 28-79 years), 13 women and 10 men. The average maximum diameter of the nodule was 8 mm (range, 3-16 mm). All patients underwent successful excision of the target lesion (success rate 100%). One patient (4.3%) sustained pneumothorax following the CT-guided injection of the radio-labelled dye and this required chest drainage prior to general anesthesia. Conclusions We conclude that technetium guided pulmonary nodule resection is a very reliable method for localization and resection of subcentimetre nodules which may be otherwise be difficult to identify.
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Affiliation(s)
- Marco Nardini
- University Hospital Policlinico di Catania, Catania, Italy
| | | | - Ian Paul
- James Cook University Hospital, Middlesbrough, UK
| | | | | | | | | | | | | | | | - Joel Dunning
- James Cook University Hospital, Middlesbrough, UK
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Jiang W, Wang Z, Chen G, Jia Y. Prognostic significance of centrosomal protein 55 in stage I pulmonary adenocarcinoma after radical resection. Thorac Cancer 2016; 7:316-22. [PMID: 27148417 PMCID: PMC4846620 DOI: 10.1111/1759-7714.12330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 11/26/2015] [Indexed: 11/29/2022] Open
Abstract
Background Pulmonary adenocarcinoma is a predominant pathologic non‐small cell lung cancer (NSCLC) with a high morbidity in China. Even at histological stage I, many patients still experience recurrence after radical surgery; therefore, it is critical to determine useful indicators to stratify patients according to recurrent risk. Centrosomal protein 55 (CEP55) shares certain characteristics with oncogenes and aberrant expression of CEP55 can lead to tumorigenesis. Therefore, we aimed to clarify the clinicopathological significance and prognostic value of CEP55 in stage I pulmonary adenocarcinoma. Methods We enrolled 106 patients with stage I pulmonary adenocarcinoma who had received complete resection in our study. CEP55 expression levels in the pulmonary tissues of all patients were validated by Western blot analyses and immunohistochemistry. SPSS 17.0 software was employed to analyze the correlation between CEP55 expression and clinicopathological characteristics of patients, as well as prognosis. Results CEP55 overexpression was detected in 67 patients (63.2%). Overexpression is associated with tumor differentiation (P = 0.036), T stage (P = 0.000) and visceral pleural invasion (P = 0.009). Patients with CEP55 overexpression had worse survival compared with those with low expression (P = 0.043). Univariate analysis revealed that T stage (P = 0.000), differentiation degree (P = 0.002), visceral pleural invasion (P = 0.000), and tumor size (P = 0.013) were also significant prognostic factors. Conclusion CEP55 is a useful predicator to improve stratification of patients with stage I pulmonary adenocarcinoma.
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Affiliation(s)
- Wenpeng Jiang
- Department of Thoracic Surgery Shandong Provincial Hospital affiliated to Shandong University Jinan Shandong China
| | - Zhou Wang
- Department of Thoracic Surgery Shandong Provincial Hospital affiliated to Shandong University Jinan Shandong China
| | - Gang Chen
- Department of Thoracic Surgery Shandong Provincial Hospital affiliated to Shandong University Jinan Shandong China
| | - Yang Jia
- Department of Thoracic Surgery Shandong Provincial Hospital affiliated to Shandong University Jinan Shandong China
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Abele JT, Allred K, Clare T, Bédard ELR. Lymphoscintigraphy in early-stage non-small cell lung cancer with technetium-99m nanocolloids and hybrid SPECT/CT: a pilot project. Ann Nucl Med 2014; 28:477-83. [PMID: 24557659 DOI: 10.1007/s12149-014-0821-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/05/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The goal of our study was to determine if lymph node activity could be visualized using a hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) scanner with two commonly used colloidal lymphatic radiotracers--99mTc-antimony sulfide colloid (ASC) and 99mTc-filtered sulfur colloid (FSC) in the setting of low-stage non-small cell lung cancer (NSCLC). METHODS Patients undergoing CT-guided percutaneous lung biopsies for clinically suspected early-stage lung cancer were randomized to peri-lesional injection of 37 MBq (0.5 mL) of either ASC or FSC. SPECT/CT of the thorax was performed at either 1, 2, or 3 h post-injection. The images were reviewed to determine if lymph node activity separate from the injection site could be identified. RESULTS 24 patients were included. Lymph node activity was identified in 50% of patients. A total of 15 lymph nodes with activity were visualized including 5 ipsilateral hilar, 6 ipsilateral mediastinal, and 4 distant locations. No contralateral mediastinal or hilar activity was visualized. There was a tendency to improved visualization with ASC and the longer 3 h wait time. Most patients also demonstrated significant pleural, tracheobronchial, and/or systemic activity. CONCLUSIONS SPECT/CT imaging can demonstrate lymph node activity separate from the injection site in at least some low-stage NSCLC patients with a perilesional injection of 99mTc nanocolloid tracers. Further investigation into the role of pre-operative lymphoscintigraphy with SPECT/CT in patients with lung cancer is warranted.
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Affiliation(s)
- Jonathan T Abele
- Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 St., 2A2.41 WMC, Edmonton, AB, T6G 2B7, Canada,
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Oh Y, Quan YH, Choi Y, Kim CK, Kim H, Kim HK, Kim BM. Intraoperative combined color and fluorescent images-based sentinel node mapping in the porcine lung: comparison of indocyanine green with or without albumin premixing. J Thorac Cardiovasc Surg 2013; 146:1509-15. [PMID: 23522603 DOI: 10.1016/j.jtcvs.2013.02.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/19/2013] [Accepted: 02/14/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We developed a multimodal optical imaging system for intraoperative visualization of sentinel lymph nodes (SLNs). This study is to validate our system by showing SLNs in the lung through combined optical color and fluorescent image with indocyanine green (ICG) and ICG with human serum albumin (HSA). METHODS Identical ICG concentrations of ICG only or ICG:HSA was injected into the rat footpad and porcine lung. Absolute amounts of the fluorescents were scaled on the basis of animal weights. The entire procedures were recorded using color and near-infrared (NIR) charge-coupled device (CCD) cameras simultaneously, and the 2 images were merged by real-time image processing software. All fluorescence intensity signals to background ratio (SBR) and retention rates at SLN for both fluorescents were estimated and compared. RESULTS This newly developed intraoperative color and fluorescence optical imaging system successfully visualized the SLNs in animal experiments. The SLNs were identified 100% for both rat and pig under in vivo conditions. Real-time image processing software overcame the low signal of NIR fluorescence images. ICG and ICG:HSA provided no significantly different SBR in the SLN images for both rat thigh and pig lung. CONCLUSIONS The intraoperative optical imaging system enabled real-time image-guided surgery during SLN mapping in lung in an animal model. The ICG retention rate was similar to ICG:HSA. ICG alone can be useful for SLN imaging during lung cancer surgery.
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Affiliation(s)
- Yujin Oh
- Department of Biomedical Engineering, Korea University, Seoul, Korea
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