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Wollbrett C, Seitlinger J, Stasiak F, Piccoli J, Streit A, Siat J, Gauchotte G, Renaud S. Clinicopathological factors associated with sentinel lymph node detection in non-small-cell lung cancer. J Cardiothorac Surg 2024; 19:145. [PMID: 38504315 PMCID: PMC10949663 DOI: 10.1186/s13019-024-02632-y] [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: 10/25/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Mapping of the pulmonary lymphatic system by near-infrared (NIR) fluorescence imaging might not always identify the first lymph node relay. The aim of this study was to determine the clinicopathologic factors allowing the identification of sentinel lymph nodes (SLNs) by NIR fluorescence imaging in thoracic surgery for non-small-cell lung cancer (NSCLC). METHODS We conducted a retrospective review of 92 patients treated for suspected or confirmed cN0 lung cancer with curative intent who underwent an intraoperative injection of indocyanine green (ICG) either by direct peritumoral injection or by endobronchial injection using electromagnetic navigational bronchoscopy (ENB). After exclusion of patients for technical failure, benign disease and metastasis, we analyzed the clinicopathologic findings of 65 patients treated for localized-stage NSCLC, comparing the group with identification of SLNs (SLN-positive group) with the group without identification of SLNs (SLN-negative group). RESULTS Forty-eight patients (73.8%) were SLN-positive. Patients with SLN positivity were more frequently female (50%) than the SLN-negative patients were (11.8%) (p = 0.006). The mean value of diffusing capacity for carbon monoxide (DLCO) was lower among the patients in the SLN-negative group (64.7% ± 16.7%) than the SLN-positive group (77.6% ± 17.2%, p < 0.01). The ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FCV) was higher in the SLN-positive group (69.0% vs. 60.8%, p = 0.02). Patients who were SLN-negative were characterized by a severe degree of emphysema (p = 0.003). There was no significant difference in pathologic characteristics. On univariate analyses, age, female sex, DLCO, FEV1/FVC, degree of emphysema, and tumor size were significantly associated with SLN detection. On multivariate analysis, DLCO > 75% (HR = 4.92, 95% CI: 1.27-24.7; p = 0.03) and female sex (HR = 5.55, 95% CI: 1.25-39.33; p = 0.04) were independently associated with SLN detection. CONCLUSIONS At a time of resurgence in the use of the sentinel lymph node mapping technique in the field of thoracic surgery, this study enabled us to identify, using multivariate analysis, two predictive factors for success: DLCO > 75% and female sex. Larger datasets are needed to confirm our results.
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Affiliation(s)
- Christophe Wollbrett
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Joseph Seitlinger
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Florent Stasiak
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Juliette Piccoli
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Arthur Streit
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Joelle Siat
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France
| | - Guillaume Gauchotte
- Department of Pathology and Molecular Biology, Nancy Regional University Hospital, Vandoeuvre-lès-Nancy, 54500, France
- Research Unit INSERM U1256, NGERE Unit, Lorraine University, Vandoeuvre-lès-Nancy, 54500, France
| | - Stéphane Renaud
- Department of Thoracic Surgery, Nancy Regional University Hospital, Vandoeuvre-lès- Nancy, 54500, France.
- Research Unit INSERM U1256, NGERE Unit, Lorraine University, Vandoeuvre-lès-Nancy, 54500, France.
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Pini C, Bottoni E, Fiz F, Giudici VM, Alloisio M, Testori A, Rodari M, Sollini M, Chiti A, Cariboni U, Antunovic L. Radioisotope-Guided Excision of Mediastinal Lymph Nodes in Patients with Non-Small Cell Lung Carcinoma: Feasibility and Clinical Impact. Cancers (Basel) 2023; 15:3320. [PMID: 37444438 DOI: 10.3390/cancers15133320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Intraoperative localisation of nodal disease in non-small cell lung cancer (NSCLC) can be challenging. Lymph node localisation via radiopharmaceuticals is used in many conditions; we tested the feasibility of this approach in NSCLC. METHODS NSCLC patients were prospectively recruited. Intraoperative peri-tumoral injections of [99mTc]Tc-albumin nanocolloids were performed, followed by removing the tumour and locoregional lymph nodes. These were examined ex vivo with a gamma probe and labelled sentinel lymph nodes (SLNs) if they showed any activity or non-sentinel lymph nodes (nSLNs) if they did not. Thereafter, the surgical field was scanned with the probe; any further radioactive lymph node was removed and labelled as "extra" SLNs (eSLNs). All specimens were sent to histology, and metastatic status was recorded. RESULTS 48 patients were enrolled, and 290 nodal stations were identified: 179 SLNs, 87 nSLNs, and 24 eSLNs. A total of 44 nodal metastases were identified in 22 patients, with 36 of them (82%) located within SLNs. Patients with nSLNs metastases had at least a co-existing positive SLN. No metastases were found in eSLNs. CONCLUSIONS The technique shows high sensitivity for intraoperative nodal metastases identification. This information could allow selective lymphadenectomies in low-risk patients or more aggressive approaches in high-risk patients.
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Affiliation(s)
- Cristiano Pini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Edoardo Bottoni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Francesco Fiz
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Ente Ospedaliero "Ospedali Galliera", 16128 Genoa, Italy
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Veronica Maria Giudici
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Marcello Rodari
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Lidija Antunovic
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
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Messina G, Bove M, Noro A, Opromolla G, Natale G, Mirra R, Capasso F, Pica DG, Di Filippo V, Pirozzi M, Caterino M, Facchini S, Zotta A, Polito R, Vicidomini G, Santini M, Fiorelli A, Ciardiello F, Fasano M. Intraoperative ultrasound: "Alternative eye" in lymph nodal dissection in non-small cell lung cancer. Thorac Cancer 2022; 13:3250-3256. [PMID: 36267041 PMCID: PMC9715883 DOI: 10.1111/1759-7714.14623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Staging of the mediastinum lymph nodes involvement in patients with non-small cell lung cancer (NSCLC) is an important prognostic factor determining the most appropriate multimodality treatment plan. The objective of this study is to assess ultrasound characteristics of mediastinal lymph nodes metastasis and effectiveness of intraoperative ultrasound-guided mediastinal nodal dissection in patients with resected NSCLC. MATERIALS AND METHODS All patients undergoing video-assisted thoracoscopic surgery lobectomy and pulmonary lymphadenectomy from November 2020 to March 2022 at the thoracic surgery department of the Vanvitelli University of Naples underwent intraoperative ultrasound-guided mediastinal lymph nodal dissection. RESULTS This study evaluates whether individual B-mode features and a compounding thereof can be used to accurately and reproducibly predict lymph node malignancy. DISCUSSION Intraoperative ultrasound, during systematic mediastinal lymph node dissection, is helpful in preventing lesion to mediastinal structures. Pathological nodal sonographic characteristics are round shape, short-axis diameter, echogenicity, margin, the absence or presence of coagulation necrosis sign, and the absence or presence of central hilar structure, increased color Doppler flow, the absence or presence of calcification, and nodal conglomeration. Operating time was not substantially prolonged. The procedure is simple, safe and highly accurate. CONCLUSIONS Ultrasonic techniques allow surgeons to detect the relationship between lymph nodes and surrounding large blood vessels during biopsy, improving the safety and simplicity of the operation, increasing the number of harvested lymph nodes, and reducing the risk of intraoperative injury; it is a fast, easily reproducible, and inexpensive method.
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Affiliation(s)
- Gaetana Messina
- Thoracic Surgery UnitUniversità degli Studi della Campania “Luigi Vanvitelli”NapoliItaly
| | - Mary Bove
- Thoracic Surgery UnitUniversità degli Studi della Campania “Luigi Vanvitelli”NapoliItaly
| | - Antonio Noro
- Thoracic Surgery UnitUniversità degli Studi della Campania “Luigi Vanvitelli”NapoliItaly
| | - Giorgia Opromolla
- Thoracic Surgery UnitUniversità degli Studi della Campania “Luigi Vanvitelli”NapoliItaly
| | - Giovanni Natale
- Thoracic Surgery UnitUniversità degli Studi della Campania “Luigi Vanvitelli”NapoliItaly
| | - Rosa Mirra
- Thoracic Surgery UnitUniversità degli Studi della Campania “Luigi Vanvitelli”NapoliItaly
| | - Francesca Capasso
- Thoracic Surgery UnitUniversità degli Studi della Campania “Luigi Vanvitelli”NapoliItaly
| | - Davide Gerardo Pica
- Thoracic Surgery UnitUniversità degli Studi della Campania “Luigi Vanvitelli”NapoliItaly
| | - Vincenzo Di Filippo
- Thoracic Surgery UnitUniversità degli Studi della Campania “Luigi Vanvitelli”NapoliItaly
| | - Mario Pirozzi
- Oncology, Department of Precision MedicineUniversità della Campania “L. Vanvitelli”NaplesItaly
| | - Marianna Caterino
- Oncology, Department of Precision MedicineUniversità della Campania “L. Vanvitelli”NaplesItaly
| | - Sergio Facchini
- Oncology, Department of Precision MedicineUniversità della Campania “L. Vanvitelli”NaplesItaly
| | - Alessia Zotta
- Oncology, Department of Precision MedicineUniversità della Campania “L. Vanvitelli”NaplesItaly
| | - Rita Polito
- Nutrition ScienceUniversity of FoggiaFoggiaItaly
| | - Giovanni Vicidomini
- Thoracic Surgery UnitUniversità degli Studi della Campania “Luigi Vanvitelli”NapoliItaly
| | - Mario Santini
- Thoracic Surgery UnitUniversità degli Studi della Campania “Luigi Vanvitelli”NapoliItaly
| | - Alfonso Fiorelli
- Oncology, Department of Precision MedicineUniversità della Campania “L. Vanvitelli”NaplesItaly
| | - Fortunato Ciardiello
- Oncology, Department of Precision MedicineUniversità della Campania “L. Vanvitelli”NaplesItaly
| | - Morena Fasano
- Oncology, Department of Precision MedicineUniversità della Campania “L. Vanvitelli”NaplesItaly
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Kawakami Y, Kondo K, Kawakita N, Matsuoka H, Toba H, Takizawa H, Yoshida M, Tangoku A. Long-term outcomes of sentinel node identification using indocyanine green in patients with lung cancer. Thorac Cancer 2020; 12:165-171. [PMID: 33219734 PMCID: PMC7812077 DOI: 10.1111/1759-7714.13737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sentinel node (SN) biopsy is used in the management of numerous cancers to avoid unnecessary lymphadenectomy. This was a clinical exploration/feasibility study of a novel identification technique for SN biopsy using indocyanine green (ICG) fluorescence imaging during lung cancer surgery. METHODS SN biopsy using ICG was performed on 22 patients who had cT1 or T2N0M0 lung cancer. ICG was injected just around the primary tumor. The fluorescence imaging system enabled visualization of the lymphatic vessels draining from the primary tumor toward the lymph nodes. Fluorescently labeled nodes were dissected, and patients were followed-up for prognosis and recurrence to confirm the pattern of lymph node metastasis after surgery. RESULTS SNs were successfully identified in 16 (72.7%) of 22 patients. A total of 13 of 16 patients had pathological N0 and three had SN metastasis. The median follow-up time was 92.7 months. Only one patient had no SN metastasis at the postoperative pathological examination and lymph node metastasis during the follow-up period. The accuracy rate was 93.8% (15/16) and the false-negative rate was 7.7% (1/13). CONCLUSIONS SNs were identified by ICG fluorescence imaging, and this technique during lung cancer surgery had good identification and accuracy rates throughout the follow-up period. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: We attempted to identify sentinel lymph nodes by indocyanine green in lung cancer surgery. The identification rate was 72.7%. The accuracy rate was 100% immediately after surgery, and 93.8% after follow-up. WHAT THIS STUDY ADDS Sentinel node biopsy by indocyanine green may be useful for lymph node dissection during lung cancer surgery to avoid unnecessary lymphadenectomy.
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Affiliation(s)
- Yukikiyo Kawakami
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kazuya Kondo
- Department of Oncological Medical Services, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Naoya Kawakita
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hisashi Matsuoka
- Department of Thoracic Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Hiroaki Toba
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Mitsuteru Yoshida
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Akira Tangoku
- Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Gregor A, Ujiie H, Yasufuku K. Sentinel lymph node biopsy for lung cancer. Gen Thorac Cardiovasc Surg 2020; 68:1061-1078. [PMID: 32661834 DOI: 10.1007/s11748-020-01432-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
Sentinel lymph node biopsy is a technique to identify the first lymph node (or nodes) draining a tumor. The underlying principle is that as the first site of cancer spread, evaluation of the sentinel node will be most predictive for wider nodal involvement. The introduction of sentinel node biopsy revolutionized the surgical management of cutaneous melanoma and breast cancer, becoming a key component in the management of such patients. For over 20 years, thoracic surgeons have similarly worked to apply this technique to lung cancer but have thus far not had the same impact on lung surgery. In this review, we will summarize the ongoing discussions on the role of sentinel node biopsy in lung cancer, the methods for identifying the sentinel node, and the techniques for evaluating the sentinel node specimen. We will also highlight some of the pressing questions investigators should consider when designing a trial for sentinel node mapping. This will clarify the current status of sentinel node biopsy in lung cancer and thus highlight important future directions for research.
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Affiliation(s)
- Alexander Gregor
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada. .,Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
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Chao YK. Deciding to trust, coming to believe: sentinel lymph node assessment in lung cancer. J Thorac Dis 2019; 10:S3978-S3980. [PMID: 30631532 DOI: 10.21037/jtd.2018.09.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan
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7
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Meacci E, Nachira D, Chiappetta M, Congedo MT, Petracca-Ciavarella L, Ferretti G, Margaritora S. Editorial on "Long-term outcomes after near-infrared sentinel lymph node mapping in non-small cell lung cancer". J Thorac Dis 2019; 10:S3922-S3926. [PMID: 30631517 DOI: 10.21037/jtd.2018.09.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Elisa Meacci
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
| | - Dania Nachira
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
| | - Marco Chiappetta
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
| | - Maria Teresa Congedo
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
| | - Leonardo Petracca-Ciavarella
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
| | - Gianmaria Ferretti
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
| | - Stefano Margaritora
- UOC di Chirurgia Toracica, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italia
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Clinical Significance of Molecular Micrometastasis in the Sentinel Lymph Node of Early-stage Non-Small Cell Lung Cancer Patients. Am J Clin Oncol 2018; 41:1106-1112. [PMID: 29509594 DOI: 10.1097/coc.0000000000000432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Metastatic affectation of lymph node is the main prognostic factor in localized lung cancer. A pathologic study of the obtained samples, even after adequate lymphadenectomy, showed tumor relapses for 20% of stage I patients after oncological curative surgery. We evaluated the prognostic value of molecular micrometastasis in the sentinel lymph node of patients with early-stage lung cancer. PATIENTS AND METHODS The sentinel node was marked immediately after performing thoracotomy by peritumorally injecting 0.25 mCi of nanocoloid of albumin (Nanocol1) labeled with Tc-99m in 0.3 mL. Guided by a Navigator1 gammagraphic sensor, we proceeded to its resection. The RNA of the tissue was extracted, and the presence of genes CEACAM5, BPIFA1, and CK7 in mRNA was studied. The significant association between the presence of micrometastasis, clinicopathologic characteristics, and patients' outcome was assessed. RESULTS Eighty-nine stage I-II non-small cell lung cancer patients were included in the study. Of the 89 analyzed sentinel lymph nodes, 44 (49.4%) were positive for CK7, 24 (26.9%) for CEACAM5, and 17 (19.1%) for BPIFA1, whereas 10 (11.2%) were positive for the 3 analyzed genes. A survival analysis showed no significant relation between the presence of molecular micrometastasis in the sentinel node and patients' progression. CONCLUSIONS The molecular analysis of the sentinel node in patients with early-stage lung cancer shows node affectation in cases staged as stage I/II by hematoxylin-eosin or an immunohistochemical analysis. However, this nodal affectation was not apparently related to patients' outcome.
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9
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Topography of the sentinel node according to the affected lobe in lung cancer. Clin Transl Oncol 2017; 19:858-864. [DOI: 10.1007/s12094-017-1615-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
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10
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Chiu CH, Chao YK, Liu YH, Wen CT, Chen WH, Wu CY, Hsieh MJ, Wu YC, Liu HP. Clinical use of near-infrared fluorescence imaging with indocyanine green in thoracic surgery: a literature review. J Thorac Dis 2016; 8:S744-S748. [PMID: 28066678 DOI: 10.21037/jtd.2016.09.70] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Invisible near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has advantage in detecting for certain anatomy. The method is currently used in some types of surgery, such as sentinel lymph node (SLN) mapping, intraoperative solid tumor identification, and organ perfusion assessment. However, the literature of clinical application in thoracic surgery is lacking. This paper presents the advantages, current applications and potential developments of NIR fluorescence imaging with ICG in thoracic surgery.
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Affiliation(s)
- Chien-Hung Chiu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Hen Liu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Tsung Wen
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Hsun Chen
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yang Wu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Cheng Wu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hui-Ping Liu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
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11
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Guidoccio F, Orsini F, Mariani G. A critical reappraisal of sentinel lymph node biopsy for non-small cell lung cancer. Clin Transl Imaging 2016. [DOI: 10.1007/s40336-016-0203-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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12
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Nomori H, Cong Y, Sugimura H. Utility and pitfalls of sentinel node identification using indocyanine green during segmentectomy for cT1N0M0 non-small cell lung cancer. Surg Today 2015; 46:908-13. [DOI: 10.1007/s00595-015-1248-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/21/2015] [Indexed: 11/25/2022]
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13
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14
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Imai K, Kawaharada Y, Ogawa JI, Saito H, Kudo S, Takashima S, Saito Y, Atari M, Ito A, Terata K, Yoshino K, Sato Y, Motoyama S, Minamiya Y. Development of a New Magnetometer for Sentinel Lymph Node Mapping Designed for Video-Assisted Thoracic Surgery in Non-Small Cell Lung Cancer. Surg Innov 2015; 22:401-5. [PMID: 25940853 DOI: 10.1177/1553350615585421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We previously developed a method for sentinel lymph node (SLN) mapping in non-small cell lung cancer (NSCLC), based on the magnetic force produced by a magnetite tracer already approved for use as a contrast material for magnetic resonance imaging. However, it is difficult to use that technique with video-assisted thoracic surgery (VATS) because the sensing element of the magnetometer is large and thick. The purpose of the present study was to develop a smaller, thinner VATS-compatible magnetometer. METHODS The tracer employed was Ferucarbotran, a colloidal solution of superparamagnetic iron oxide coated with carbodextran. Fifteen patients with clinical stage I NSCLC were enrolled, and each received 1.6 mL of Ferucarbotran, injected intraoperatively at 5 points around the tumor. The magnetic force within the sampling lymph nodes was measured using the new VATS-compatible magnetometer. RESULTS SLNs were detected in 11 (73.3%) of the 15 patients using the VATS-compatible magnetometer. The average number of SLNs identified per patient was 1.8 (range 0-4). No complications related to the SLN detection method were observed. CONCLUSIONS The new VATS-compatible magnetometer appears to have substantial advantages over techniques using a radioisotope and our earlier magnetometer, as it can be inserted through the small VATS port site.
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Affiliation(s)
- Kazuhiro Imai
- Akita University Graduate School of Medicine, Akita, Japan
| | | | - Jun-Ichi Ogawa
- Akita University Graduate School of Medicine, Akita, Japan
| | - Hajime Saito
- Akita University Graduate School of Medicine, Akita, Japan
| | - Satoshi Kudo
- Akita University Graduate School of Medicine, Akita, Japan
| | | | | | - Maiko Atari
- Akita University Graduate School of Medicine, Akita, Japan
| | - Aki Ito
- Akita University Graduate School of Medicine, Akita, Japan
| | - Kaori Terata
- Akita University Graduate School of Medicine, Akita, Japan
| | - Kei Yoshino
- Akita University Graduate School of Medicine, Akita, Japan
| | - Yusuke Sato
- Akita University Graduate School of Medicine, Akita, Japan
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Galbis Caravajal JM, Cremades Mira A, Zuñiga Cabrera Á, Estors Guerrero M, Tembl Ferrairó A, Martinez Hernandez NJ, Gironés Sarrió R, Aparisi Aparisi F, Gaspar Martinez C. El ganglio centinela en el carcinoma pulmonar. Estudio molecular tras detección con radioisótopo. Cir Esp 2014. [DOI: 10.1016/j.ciresp.2013.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Juričić J, Ilić N, Frleta Ilić N, Ilić D, Mrklić I, Pogorelić Z. Improved staging using intraoperative ultrasound for mediastinal lymphadenectomy in non-small lung cancer surgery. Surgeon 2013; 12:191-4. [PMID: 24368191 DOI: 10.1016/j.surge.2013.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/20/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Extent of lymph node involvement in patients with non-small cell lung cancer (NSCLC) is the cornerstone of staging and influences both multimodality treatment and final outcome. The aim of this study was to investigate accuracy and characteristics of intraoperative ultrasound guided systematic mediastinal nodal dissection in patients with resected NSCLC. METHODS From January 2008 to June 2013, 244 patients undergoing intraoperative surgical staging after radical surgery for NSCLC were included in prospective study. The patients were divided in two groups according to systematic mediastinal nodal dissection: 124 patients in intraoperative ultrasound nodal dissection guided group and 120 in standard nodal dissection group. The lymph nodes were mapped by their number and station and histopathologic evaluation was performed. RESULTS Operating time was prolonged for 10 min in patients with ultrasound guided mediastinal nodal dissection, but number and stations of evaluated lymph nodes were significantly higher (p < 0.001) in the same group. Skip nodal metastases were found in 24% of patients without N1 nodal involvement. Twelve (10%) patients were upstaged using US guided mediastinal lymphadenectomy. In US guided group 5-year survival rate was 59% and in the group of standard systematic mediastinal lymphadenectomy 43% (p = 0.001) Standard staging system seemed to be improved in ultrasound guided mediastinal lymphadenectomy patients. Complication rate showed no difference between analyzed groups. CONCLUSION Higher number and location of analyzed mediastinal nodal stations in patients with resected NSCLC using ultrasound is suggested to be of great oncological significance. Our results indicate that intraoperative ultrasound may have important staging implications.
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Affiliation(s)
- Joško Juričić
- Department of Surgery, Split University Hospital Centre, Spinčićeva 1, 21 000 Split, Croatia
| | - Nenad Ilić
- Department of Surgery, Split University Hospital Centre, Spinčićeva 1, 21 000 Split, Croatia
| | | | - Darko Ilić
- Department of Anaesthesiology, Split University Hospital Centre, Spinčićeva 1, 21 000 Split, Croatia
| | - Ivana Mrklić
- Department of Pathology, Split University Hospital Centre, Spinčićeva 1, 21 000 Split, Croatia
| | - Zenon Pogorelić
- Department of Pediatric Surgery, Split University Hospital Centre, Spinčićeva 1, 21 000 Split, Croatia.
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Oh Y, Lee YS, Quan YH, Choi Y, Jeong JM, Kim BM, Kim HK. Thoracoscopic color and fluorescence imaging system for sentinel lymph node mapping in porcine lung using indocyanine green-neomannosyl human serum albumin: intraoperative image-guided sentinel nodes navigation. Ann Surg Oncol 2013; 21:1182-8. [PMID: 24310791 DOI: 10.1245/s10434-013-3381-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Indexed: 01/05/2023]
Abstract
PURPOSE This study was performed to validate a newly developed sentinel lymph node (SLN) targeting tracer, indocyanine green-neomannosyl human serum albumin (ICG:MSA), and a thoracoscopic version of the intraoperative color and fluorescence imaging system (ICFIS) for lung cancer SLN mapping. METHODS ICG alone or ICG:MSA (5 μg/kg) was injected into the rat thigh, and the results were compared. The fluorescence signal-to-background ratios of SLNs were recorded and evaluated over a 2-h period by using ICFIS. Additionally, a SLN biopsy was performed via video-assisted thoracoscopic surgery with the use of ICG:MSA in porcine lung by using thoracoscopic ICFIS. RESULTS The newly developed ICG:MSA showed a significantly improved signal-to-background ratio compared with ICG alone throughout the trials. All SLNs were identified in both rats (ten SLNs in ten rat thighs) and pigs (ten SLNs in ten porcine lungs) under in vivo conditions. All SLNs were dissected successfully by using video-assisted thoracoscopic surgery with the help of thoracoscopic ICFIS. DISCUSSION ICG:MSA accumulates in the SLN by uptake and retention through the mannose-specific receptors on macrophages. Thoracoscopic ICFIS successfully assisted SLN mapping despite low near-infrared light transmission in the commercial thoracoscope. On the basis of the results of the thoracoscopic SLN mapping, we anticipate that ICG:MSA and thoracoscopic ICFIS can be translated to clinical trials in the near future.
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Affiliation(s)
- Yujin Oh
- Department of Bio-Convergence, Korea University, Seoul, Korea
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Cousins A, Thompson SK, Wedding AB, Thierry B. Clinical relevance of novel imaging technologies for sentinel lymph node identification and staging. Biotechnol Adv 2013; 32:269-79. [PMID: 24189095 DOI: 10.1016/j.biotechadv.2013.10.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/12/2013] [Accepted: 10/27/2013] [Indexed: 01/07/2023]
Abstract
The sentinel lymph node (SLN) concept has become a standard of care for patients with breast cancer and melanoma, yet its clinical application to other cancer types has been somewhat limited. This is mainly due to the reduced accuracy of conventional SLN mapping techniques (using blue dye and/or radiocolloids as lymphatic tracers) in cancer types where lymphatic drainage is more complex, and SLNs are within close proximity to other nodes or the tumour site. In recent years, many novel techniques for SLN mapping have been developed including fluorescence, x-ray, and magnetic resonant detection. Whilst each technique has its own advantages/disadvantages, the role of targeted contrast agents (for enhanced retention in the SLN, or for immunostaging) is increasing, and may represent the new standard for mapping the SLN in many solid organ tumours. This review article discusses current limitations of conventional techniques, limiting factors of nanoparticulate based contrast agents, and efforts to circumvent these limitations with modern tracer architecture.
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Affiliation(s)
- Aidan Cousins
- Ian Wark Research Institute, University of South Australia, Mawson Lakes Campus, Mawson Lakes, SA 5095, Australia
| | - Sarah K Thompson
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - A Bruce Wedding
- School of Engineering, University of South Australia, Mawson Lakes Campus, Mawson Lakes, SA 5095, Australia
| | - Benjamin Thierry
- Ian Wark Research Institute, University of South Australia, Mawson Lakes Campus, Mawson Lakes, SA 5095, Australia.
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Karamustafaoglu YA, Yoruk Y, Yanik F, Sarikaya A. Sentinel lymph node mapping in patients with operable non-small cell lung cancer. J Thorac Dis 2013; 5:317-20. [PMID: 23825767 DOI: 10.3978/j.issn.2072-1439.2013.06.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/31/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND The aim of this study was to determine the accuracy and the role of the sentinel lymph node (SLN) in patients with non-small cell lung cancer. MATERIAL AND METHOD This study was carried out on 25 consecutive patients [M/F=23(:)2, mean age 62.84 (47-81) years] with operable non-small cell lung cancer (NSCLC). At thoracotomy, 0.25 mCi of Technecium(99m) (99mTc) nanocolloid was injected into each quadrant of lung tissue surrounding the tumor. Before resection scintigraphic measurements of lymph nodes were obtained in vivo and ex vivo using a hand-held gamma probe counter and the findings were compared with histological examination. SLN was defined as the node with the highest count rate. RESULTS SLNs were identified in 23 of 25 patients (92%) with a total number of 52 SLNs. Seven of 52 (13%) of these SLNs were positive for metastatic involvement after histological and immunohistochemical examination. In two patients (8%), SLNs could not be found. The sensitivity and specificity were 55% and 86% respectively. CONCLUSIONS This technic is a good method for identifying the first site of potential nodal metastases of NSCLC. These preliminary results demonstrate this procedure is feasible, but the detection rate has to be improved.
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The role of SHP-1 promoter 2 hypermethylation detection of lymph node micrometastasis in resectable stage I non-small cell lung cancer as a prognostic marker of disease recurrence. Int J Clin Oncol 2013; 19:586-92. [DOI: 10.1007/s10147-013-0590-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/17/2013] [Indexed: 02/02/2023]
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Gilmore DM, Khullar OV, Jaklitsch MT, Chirieac LR, Frangioni JV, Colson YL. Identification of metastatic nodal disease in a phase 1 dose-escalation trial of intraoperative sentinel lymph node mapping in non-small cell lung cancer using near-infrared imaging. J Thorac Cardiovasc Surg 2013; 146:562-70; discussion 569-70. [PMID: 23790404 DOI: 10.1016/j.jtcvs.2013.04.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 04/01/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Early-stage non-small cell lung cancer (NSCLC) has a high recurrence rate and poor 5-year survival, particularly if lymph nodes are involved. Our objective was to perform a dose-escalation study to assess safety and feasibility of intraoperative near-infrared (NIR) fluorescence imaging to identify the first tumor-draining lymph nodes (ie, sentinel lymph nodes [SLNs] in patients with NSCLC). METHODS A-dose escalation phase 1 clinical trial assessing real-time NIR imaging after peritumoral injection of 3.8 to 2500 μg indocyanine green (ICG) was initiated in patients with suspected stage I/II NSCLC. Visualization of lymphatic migration, SLN identification, and adverse events were recorded. RESULTS Thirty-eight patients underwent ICG injection and NIR imaging via thoracotomy (n = 18) or thoracoscopic imaging (n = 20). SLN identification increased with ICG dose, with fewer than 25% SLNs detected in dose cohorts of 600 μg or less versus 89% success at 1000 μg or greater. Twenty-six NIR(+) SLNs were identified in 15 patients, with 7 NIR(+) SLNs (6 patients) harboring metastatic disease on histologic analysis. Metastatic nodal disease was never identified in patients with a histologically negative NIR(+) SLN. No adverse reactions were noted. CONCLUSIONS NIR-guided SLN identification with ICG was safe and feasible in this initial dose-escalation trial. ICG doses greater than 1000 μg yielded nearly 90% intrathoracic SLN visualization, with the presence or absence of metastatic disease in the SLN directly correlating with final nodal status of the lymphadenectomy specimen. Further studies are needed to optimize imaging parameters and confirm sensitivity and specificity of SLN mapping in NSCLC using this promising imaging technique.
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Affiliation(s)
- Denis M Gilmore
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass 02115, USA
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Abstract
In cases of superficial malignancies such as melanoma or breast cancer, intraoperative lymph node mapping with a sentinel lymph node (SLN) biopsy is an effective and minimally invasive alternative to inguinal or axillary lymph node dissection for early-stage tumors. For primary lung cancer, although much effort has been made to investigate a variety of tracers, such as dyes, radioisotopes, magnetite, and iopamidol, for discerning SLNs, an appropriate agent that produces high identification and accuracy rates has yet to be developed. Further studies are needed to find an ideal tracer for practical use in patients with non-small cell lung cancer.
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Affiliation(s)
- Shinichiro Miyoshi
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery (Surgery II), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-ku, Okayama 700-8558, Japan.
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Nwogu CE, Yendamuri S, Tan W, Kannisto E, Bogner P, Morrison C, Cheney R, Dexter E, Picone A, Hennon M, Hutson A, Reid M, Adjei A, Demmy TL. Lung cancer lymph node micrometastasis detection using real-time polymerase chain reaction: correlation with vascular endothelial growth factor expression. J Thorac Cardiovasc Surg 2013; 145:702-7; discussion 707-8. [PMID: 23414988 DOI: 10.1016/j.jtcvs.2012.12.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 08/17/2012] [Accepted: 12/10/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Lymph node staging provides critical information in patients with non-small cell lung cancer (NSCLC). Lymphangiogenesis may be an important contributor to the pathophysiology of lymphatic metastases. We hypothesized that the presence of lymph node micrometastases positively correlates with vascular endothelial growth factors (VEGFs) A, C, and D as well as VEGF-receptor-3 (lymphangiogenic factors) expression in lymph nodes. METHODS Forty patients with NSCLC underwent preoperative positron emission tomography-computed tomography and mediastinoscopy. Real-time polymerase chain reaction (RT-PCR) assays for messenger RNA expression of epithelial markers (ie, cytokeratin 7; carcinoembryonic antigen-related cell adhesion molecule 5; and palate, lung, and nasal epithelium carcinoma-associated protein) were performed in selected fluorodeoxyglucose-avid lymph nodes. VEGF-A, VEGF-C, VEGF-D, and VEGF receptor-3 expression levels were measured in primary tumors and lymph nodes. Wilcoxon rank sum test was run for the association between the RT-PCR epithelial marker levels and VEGF expression levels in the lymph nodes. RESULTS RT-PCR for cytokeratin 7; carcinoembryonic antigen-related cell adhesion molecule 5; or palate, lung, and nasal epithelium carcinoma-associated protein indicated lymph node micrometastatic disease in 19 of 35 patients (54%). There was a high correlation between detection of micrometastases and VEGF-A, VEGF-C, VEGF-D, or VEGF receptor-3 expression levels in lymph nodes. Median follow-up was 12.6 months. CONCLUSIONS RT-PCR analysis of fluorodeoxyglucose-avid lymph nodes results in up-staging a patient's cancer. Micrometastases correlate with the expression of VEGF in lymph nodes in patients with NSCLC. This may reflect the role of lymphangiogenesis in promoting metastases.
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Affiliation(s)
- Chukwumere E Nwogu
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Sentinel lymph node in thyroid tumors - own experience. Contemp Oncol (Pozn) 2013; 17:184-9. [PMID: 23788988 PMCID: PMC3685375 DOI: 10.5114/wo.2013.34623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 01/25/2013] [Accepted: 02/05/2013] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY To determine the feasibility of sentinel lymph node biopsy (SLNB) for the evaluation of the cervical lymph node status in patients with thyroid tumors. MATERIAL AND METHODS Twenty-three patients with suspected thyroid cancer were enrolled in the study. 0.5-1.0 ml of 1% Patent Blue dye was injected intratumorally. After SLNB, thyroidectomy and proper lymphadenectomy were performed. RESULTS Sentinel lymph node was detected in 20 (86.9%) patients. Thirty-one SLNs were found - 21 (67.7%) were located in the central neck compartment, 4 (12.9%) in the lateral neck compartment, 6 (19.4%) in the upper mediastinum. The number of SLNs ranged from 1 to 3 (mean 1.6). Sentinel lymph node was positive in 5 (25%) patients, negative in 15 (75%) in the final histopathology. Sentinel lymph nodes were located only in the central neck compartment in 13 patients, and in both the central and lateral neck compartments in 2 patients. In one patient, SLNs were located only in the central neck compartment and upper mediastinum. Three patients had SLNs only in the upper mediastinum, while one had them only in the lateral neck compartment. In one patient a node regarded as SLN was negative, while there were metastases in removed non-sentinel lymph nodes (NSLNs). In two patients, histopathology of SLNs showed that they were actually parathyroid glands. CONCLUSIONS Our results confirm that thyroid cancer SLNB is rather easy to carry out. Its performance along with intraoperative examination can help to avoid unnecessary lymphadenectomy. However, it should be kept in mind that parathyroid glands can be stained and removed by mistake during SLNB.
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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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Wang YXJ, Wang DW, Zhu XM, Zhao F, Leung KC. Carbon coated superparamagnetic iron oxide nanoparticles for sentinel lymph nodes mapping. Quant Imaging Med Surg 2012; 2:53-6. [PMID: 23256059 DOI: 10.3978/j.issn.2223-4292.2011.12.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 12/07/2011] [Indexed: 11/14/2022]
Abstract
Intra-operative lymphatic mapping and sentinel lymph-adenectomy (LM/SL) maps the lymphatic path from the primary tumor to the regional nodes and permits selective excision of the first sentinel lymph nodes. It is a well established technique to detect occult regional node metastases for melanoma patients and breast cancer patients. In continuing attempts to improve accuracy, most surgeons now combine a dye (such as carbon particles) and radiopharmaceuticals when performing LM/SL. We developed a proto-type of carbon coated superparamagnetic iron oxide nanoparticles (SPIO@C) for sentinel lymph nodes mapping. Compared with combining carbon particles and radiopharmaceuticals for performing LM/SL, there are a number of advantages with our approach: I. SPIO is an MRI contrast agent, thus pre-operative MRI may be used for LM/SL instead of gamma camera. There is no radiation associated with MRI, and MRI offers good tissue contrast and detailed cross-sectional images. II. There will be only needed one injection of SPIO@C nanoparticles, instead of administrating two successive injections of radiopharmaceuticals and carbon particles. III. During the operation, an intra-operative MRI scanner can be used, or more conveniently by a simple magnetometer.
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Affiliation(s)
- Yi-Xiang J Wang
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, P. R. China
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Mediastinal lymph nodes: ignore? sample? dissect? The role of mediastinal node dissection in the surgical management of primary lung cancer. Gen Thorac Cardiovasc Surg 2012; 60:724-34. [PMID: 22875714 DOI: 10.1007/s11748-012-0086-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Indexed: 10/28/2022]
Abstract
The role of mediastinal lymph node dissection (MLND) during the resection of non-small-cell lung cancer is still unclear although most surgeons agree that a minimum of hilar and mediastinal nodes must be examined for appropriate pathological staging. Current surgical practices vary from visual inspection of the mediastinum with biopsy of only abnormal looking nodes to systematic mediastinal node sampling which is to the biopsy of lymph nodes from multiple levels whether they appear abnormal or not to MLND which involves the systematic removal of all lymph node bearing tissue from multiple sites unilaterally or bilaterally within the mediastinum. This review article looks at the evidence and arguments in favour of lymphadenectomy, including improved pathological staging, better locoregional control, and ultimately longer disease-free survival and those against which are longer operating time, increased operative morbidity, and lack of evidence for survival benefit.
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Gilmore DM, Khullar OV, Colson YL. Developing intrathoracic sentinel lymph node mapping with near-infrared fluorescent imaging in non-small cell lung cancer. J Thorac Cardiovasc Surg 2012; 144:S80-4. [PMID: 22726707 DOI: 10.1016/j.jtcvs.2012.05.072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 04/06/2012] [Accepted: 05/18/2012] [Indexed: 11/16/2022]
Abstract
With poor survival and high recurrence rates, early-stage lung cancer currently appears to be understaged or undertreated, or both. Although sentinel lymph node biopsy is standard for patients with breast cancer and melanoma, its success has been unreliable in non-small cell lung cancer. Sentinel lymph node biopsy might aid in the identification of lymph nodes at the greatest risk of metastasis and allow for more detailed analysis to select for patients who might benefit from adjuvant therapy. The early results in our recent clinical trial of patients with early-stage lung cancer have suggested that near-infrared imaging might offer a platform for reliable sentinel lymph node identification in these patients.
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Affiliation(s)
- Denis M Gilmore
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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Kim HK, Kim S, Sung HK, Lee YS, Jeong JM, Choi YH. Comparison between Preoperative Versus Intraoperative Injection of Technetium-99 m Neomannosyl Human Serum Albumin for Sentinel Lymph Node Identification in Early Stage Lung Cancer. Ann Surg Oncol 2011; 19:1343-9. [DOI: 10.1245/s10434-011-2130-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Indexed: 11/18/2022]
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Affiliation(s)
- Mark B Faries
- Department of Surgical Oncology, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA
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Yamashita SI, Tokuishi K, Miyawaki M, Anami K, Moroga T, Takeno S, Chujo M, Yamamoto S, Kawahara K. Sentinel node navigation surgery by thoracoscopic fluorescence imaging system and molecular examination in non-small cell lung cancer. Ann Surg Oncol 2011; 19:728-33. [PMID: 22101727 DOI: 10.1245/s10434-011-2145-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE The application of sentinel node navigation surgery in non-small cell lung cancer (NSCLC) is not popular because of the difficulty of sentinel node identification and the low incidence of complications after systemic lymph node dissection. We report the intraoperative assessment of sentinel node metastasis by thoracoscopic ICG fluorescence imaging system and real-time reverse transcription-polymerase chain reaction (RT-PCR). METHODS Sixty-one patients who underwent surgery between January 2009 and December 2010 were investigated for sentinel node biopsy. ICG fluorescence imaging was applied by an infrared light CCD system, and sentinel nodes were identified and dissected. Intraoperative real-time quantitative RT-PCR to determine the expression of cytokeratin 19 (CK-19) was performed for evaluation of metastasis and finally histologic examination of hematoxylin and eosin-stained, paraffin-embedded sections. RESULTS Sixteen (80%) of 20 patients with segmentectomy and 33 (80.5%) of 41 with lobectomy were identified for sentinel lymph nodes. The total identification rate was 80.3% (49 of 61). The false-negative rate was 2.1% (1 of 49). The overall accuracy rate was 78.7% (48 of 61 patients). Disease of four of these patients was upstaged to stage IIA by RT-PCR for CK-19 expression, which was positive for sentinel nodes and micrometastases. CONCLUSIONS These results demonstrated that thoracoscopic ICG fluorescence imaging-guided surgery and real-time quantitative RT-PCR were useful for sentinel node biopsy and might be a powerful tool for more focused pathologic or molecular evaluation for staging.
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Affiliation(s)
- Shin-ichi Yamashita
- Department of Surgery II, Faculty of Medicine, Oita University, Oita, Japan.
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Moroga T, Yamashita SI, Tokuishi K, Miyawaki M, Anami K, Yamamoto S, Kawahara K. Thoracoscopic segmentectomy with intraoperative evaluation of sentinel nodes for stage I non-small cell lung cancer. Ann Thorac Cardiovasc Surg 2011; 18:89-94. [PMID: 22082811 DOI: 10.5761/atcs.oa.11.01726] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Segmentectomy is the treatment of choice for small-sized non-small cell lung cancer (NSCLC); however, it is difficult to decide the surgical procedure because accurate evaluation of hilar lymph node metastasis remains unclear. We here report the outcome of video-assisted thoracic surgery (VATS) segmentectomy with and without the assessment of sentinel nodes. MATERIALS AND METHODS Eighty-three patients with stage IA NSCLC underwent VATS segmentectomy between January 2003 and December 2010. Twenty patients underwent indocyanine green fluorescence imaging for sentinel node biopsy (SNB) and 63 did not. Intraoperative real-time quantitative RT-PCR to determine the expression of CK-19 was used for evaluation of metastasis. Perioperative outcome, local recurrence rates and survival were compared in both groups. RESULTS Sentinel lymph nodes were identified in 16 of 20 patients (80%) with segmentectomy in the SNB group. The false negative rate was 0%. By RT-PCR for CK-19 expression, only one of these patients showed positive sentinel nodes, which indicated isolated tumor cells; however, segmentectomy was not converted to lobectomy. Seven of 63 patients with VATS segementectomy without SNB and none of the SNB group relapsed. In the relapsed patients without SNB, 4 (6.3%) were local recurrences and 3 (4.7%) were distant metastases. Recurrence-free survival rates in both groups were not significantly different because of the short follow-up period of the SNB group. CONCLUSIONS Our study demonstrated that VATS segmentectomy with SNB was useful for deciding intraoperatively to perform segmentectomy with an accurate lymph node status.
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Affiliation(s)
- Toshihiko Moroga
- Department of Surgery II, Faculty of Medicine, Oita University, Yufu, Oita, Japan
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Sentinel Lymph Node in Nonmelanoma Skin Cancer. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2011.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Salguero-Fernández I, Rios-Buceta L, Jaén-Olasolo P. Ganglio centinela en cáncer de piel no melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:589-98. [DOI: 10.1016/j.ad.2011.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 04/28/2011] [Accepted: 05/26/2011] [Indexed: 12/12/2022] Open
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Sentinel nodes in lung cancer: review of our 10-year experience. Surg Today 2011; 41:889-95. [PMID: 21748602 DOI: 10.1007/s00595-010-4528-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 09/15/2010] [Indexed: 10/18/2022]
Abstract
Sentinel node (SN) identification in patients with lung cancer is useful not only to minimize lymph node dissection, but also to target the best lymph nodes for intraoperative frozen section during segmentectomy. Since 2000, we have identified the SN in lung cancer patients using radioisotope (RI). This review presents our data on SN identification, describing the following: the procedure, using a radioisotope tracer; the flow of Tc-99 tin colloid after the injection; the characteristics of patients whose SNs could not be identified; ex vivo SN identification; reliability of in vivo SN identification; the algorithm for reducing mediastinal lymph node dissection; the differences in SN identification between large and small radioisotope particles; SNs at segmental lymph nodes; SN navigation segmentectomy for clinical stage IA non-small cell lung cancer; and small metastasis in the SN.
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Leong SPL, Zuber M, Ferris RL, Kitagawa Y, Cabanas R, Levenback C, Faries M, Saha S. Impact of nodal status and tumor burden in sentinel lymph nodes on the clinical outcomes of cancer patients. J Surg Oncol 2011; 103:518-30. [PMID: 21480244 DOI: 10.1002/jso.21815] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The validation of sentinel lymph node (SLN) concept in melanoma and breast cancer has established a new paradigm in cancer metastasis that, in general, cancer cells spread in a orderly fashion from the primary site to the SLNs in the regional nodal basin and then to the distant sites. In this review article, we examine the development of SLN concept in penile carcinoma, melanoma and breast carcinoma and its application to other solid cancers with emphasis of the relationship between micrometastasis in SLNs and clinical outcomes.
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Affiliation(s)
- Stanley P L Leong
- Center for Melanoma Research and Treatment, Department of Surgery, California Pacific Medical and Research Institute, San Francisco, California 94115, USA.
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Nomori H. Sentinel node mapping in lung cancer: the Japanese experience. Semin Thorac Cardiovasc Surg 2010; 21:316-22. [PMID: 20226344 DOI: 10.1053/j.semtcvs.2009.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2009] [Indexed: 11/11/2022]
Abstract
The reduction in lymph node dissection using sentinel node (SN) identification in patients with lung cancer is associated with several difficulties, compared with similar procedures in patients with breast cancer or melanoma. To overcome the difficulties of SN identification in lung cancer, several topics have been reported in Japan. In this study, the following topics regarding SN identification in lung cancer patients will be introduced: (1) devices for SN identification using a radioisotope tracer; (2) movement of Tc-99 tin colloid after injection; (3) characteristics of patients in whom SNs could not be identified; (4) results of ex vivo SN identification; (5) reliability of in vivo SN identification; (6) algorithm for reducing mediastinal lymph node dissection; (7) SN identification using SPECT/CT; (8) differences in SN identification between large and small radioisotope particles; (9) size of metastatic and nonmetastatic mediastinal lymph nodes in non-small cell lung cancer; (10) SN navigation segmentectomy for clinical stage IA non-small cell lung cancer; and (11) lymphatic flow at segmental lymph nodes.
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Affiliation(s)
- Hiroaki Nomori
- Division of General Thoracic Surgery, Department of Surgery, Keio University, School of Medicine, Tokyo, Japan.
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Khullar O, Frangioni JV, Grinstaff M, Colson YL. Image-guided sentinel lymph node mapping and nanotechnology-based nodal treatment in lung cancer using invisible near-infrared fluorescent light. Semin Thorac Cardiovasc Surg 2010; 21:309-15. [PMID: 20226343 DOI: 10.1053/j.semtcvs.2009.11.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2009] [Indexed: 02/05/2023]
Abstract
Current methods for sentinel lymph node (SLN) mapping and nodal treatment in lung cancer remain inadequate for routine clinical use. In this study, we discuss the potential for using the combination of invisible near-infrared (NIR) fluorescent light and nanotechnology for these applications. NIR fluorescence imaging has recently received significant attention for in vivo imaging applications because of its low tissue autofluorescence, high photon penetration into living tissue, and high signal-to-background ratio. Our large animal in vivo studies have been able to successfully identify SLNs in lung tissue, and several clinical studies have examined the use of NIR fluorescence imaging systems for SLN mapping in breast and gastric cancer. Promising new nanoparticle technologies, when combined with NIR fluorescence imaging, offer the potential for image-guided treatment of lymph nodes at high risk for tumor recurrence. This review provides a theoretic and empiric framework for developing the next generation of diagnostic and therapeutic agents for lung cancer.
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Affiliation(s)
- Onkar Khullar
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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40
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Nwogu C. Sentinel node and positron emission tomography mapping in lung cancer. Semin Thorac Cardiovasc Surg 2010; 21:323-6. [PMID: 20226345 DOI: 10.1053/j.semtcvs.2009.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2009] [Indexed: 11/11/2022]
Abstract
Radioguided lymph node mapping can potentially improve staging in locoregional non-small cell lung cancer. This is accomplished by using advanced pathologic techniques to detect micrometastases in selected thoracic lymph nodes. The use of isosulfan blue, technetium-99m and (18)F-fluorodeoxyglucose (FDG) as mapping agents have been reported. Despite several limitations in this technique, it may facilitate the selection of patients for novel therapies, resulting in improved outcomes for lung cancer patients.
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Affiliation(s)
- Chukwumere Nwogu
- Department of Surgery, University at Buffalo, SUNY, Buffalo, New York, USA.
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41
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Kim S, Kim HK, Kang DY, Jeong JM, Choi YH. Intra-operative sentinel lymph node identification using a novel receptor-binding agent (technetium-99m neomannosyl human serum albumin, 99mTc-MSA) in stage I non-small cell lung cancer. Eur J Cardiothorac Surg 2010; 37:1450-6. [DOI: 10.1016/j.ejcts.2010.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 12/31/2009] [Accepted: 01/06/2010] [Indexed: 11/26/2022] Open
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Video-assisted thoracoscopic indocyanine green fluorescence imaging system shows sentinel lymph nodes in non-small-cell lung cancer. J Thorac Cardiovasc Surg 2010; 141:141-4. [PMID: 20392454 DOI: 10.1016/j.jtcvs.2010.01.028] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 12/20/2009] [Accepted: 01/18/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The primary objective was to assess the feasibility and accuracy of intraoperative sentinel lymph node mapping by using a video-assisted thoracoscopic indocyanine green fluorescence imaging system in patients with clinical stage I non-small-cell lung cancer. METHODS Thirty-one patients who underwent operation between January 2009 and September 2009 were investigated for sentinel node biopsy. Indocyanine green fluorescence imaging was applied by an infrared light charge-coupled device, and sentinel nodes were identified intraoperatively and dissected. Histologic examination by hematoxylin-eosin staining was used to evaluate metastases. RESULTS Sentinel lymph nodes were identified by segmentectomy in 11 of 14 patients (78.5%) and by lobectomy in 14 of 17 patients (82.4%). The total identification rate was 80.7% (25/31 patients), the false-negative rate was 0% (0/24 patients), and the overall accuracy rate was 80.7% (25/31 patients). CONCLUSION Video-assisted thoracoscopic indocyanine green fluorescence image-guided surgery is feasible for sentinel node biopsy and may be a powerful tool to eliminate unnecessary lymph node dissection in patients with lung cancer.
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Celikoglu F, Celikoglu SI, Goldberg EP. Intratumoural chemotherapy of lung cancer for diagnosis and treatment of draining lymph node metastasis. J Pharm Pharmacol 2010; 62:287-95. [DOI: 10.1211/jpp.62.03.0001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
Objectives
Reviewed here is the potential effectiveness of cytotoxic drugs delivered by intratumoural injection into endobronchial tumours through a bronchoscope for the treatment of non-small cell lung cancer and the diagnosis of occult or obvious cancer cell metastasis to mediastinal lymph nodes.
Key findings
Intratumoural lymphatic treatment may be achieved by injection of cisplatin or other cytotoxic drugs into the malignant tissue located in the lumen of the airways or in the peribronchial structures using a needle catheter through a flexible bronchoscope. This procedure is termed endobronchial intratumoural chemotherapy and its use before systemic chemotherapy and/or radiotherapy or surgery may provide a prophylactic or therapeutic treatment for eradication of micrometastases or occult metastases that migrate to the regional lymph nodes draining the tumour area.
Conclusions
To better elucidate the mode of action of direct injection of cytotoxic drugs into tumours, we review the physiology of lymphatic drainage and sentinel lymph node function. In this light, the potential efficacy of intratumoural chemotherapy for prophylaxis and locoregional therapy of cancer metastasis via the sentinel and regional lymph nodes is indicated. Randomized multicenter clinical studies are needed to evaluate this new and safe procedure designed to improve the condition of non-small cell lung cancer patients and prolong their survival.
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Affiliation(s)
- Firuz Celikoglu
- Cerrahpasa Medical Faculty and Institute of Lung Diseases and Tuberculosis, University of Istanbul, Istanbul, Turkey
| | - Seyhan I Celikoglu
- Cerrahpasa Medical Faculty and Institute of Lung Diseases and Tuberculosis, University of Istanbul, Istanbul, Turkey
| | - Eugene P Goldberg
- Biomaterials Center, Department Materials Science and Engineering, University of Florida, Gainesville, FL, USA
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Nomori H, Ohba Y, Yoshimoto K, Shibata H, Shiraishi K, Mori T. Positron emission tomography in lung cancer. Gen Thorac Cardiovasc Surg 2009; 57:184-91. [PMID: 19367450 DOI: 10.1007/s11748-008-0371-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Indexed: 11/28/2022]
Abstract
Recent advances in positron emission tomography (PET) with 2-deoxy-2-fluoro [F-18]-D: -glucose (FDG) has enabled not only the diagnosis and staging of lung cancer but also the prediction of its malignancy grade. However, FDG-PET has been known to have several pitfalls for imaging of lung cancer. For the effective clinical use of FDG-PET in lung cancer, we reviewed the pitfalls of using FDG-PET in the diagnosis of pulmonary nodules, semiquantitative analysis of FDG-uptake, N-staging, prediction of tumor aggressiveness, prognostic significance, and prediction of pathological response after chemoradiotherapy.
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Affiliation(s)
- Hiroaki Nomori
- Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, 860-8556, Japan.
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Nomori H, Ohba Y, Yoshimoto K, Shibata H, Mori T, Shiraishi S, Kawanaka K, Kobayashi T. Difference of Sentinel Lymph Node Identification Between Tin Colloid and Phytate in Patients With Non–Small Cell Lung Cancer. Ann Thorac Surg 2009; 87:906-10. [DOI: 10.1016/j.athoracsur.2008.12.070] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 12/21/2008] [Accepted: 12/22/2008] [Indexed: 11/16/2022]
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Intraoperative Sentinel Node Mapping with Technitium-99 in Lung Cancer: Results of CALGB 140203 Multicenter Phase II Trial. J Thorac Oncol 2009; 4:198-202. [DOI: 10.1097/jto.0b013e318194a2c3] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Povoski SP, Neff RL, Mojzisik CM, O'Malley DM, Hinkle GH, Hall NC, Murrey DA, Knopp MV, Martin EW. A comprehensive overview of radioguided surgery using gamma detection probe technology. World J Surg Oncol 2009; 7:11. [PMID: 19173715 PMCID: PMC2653072 DOI: 10.1186/1477-7819-7-11] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Accepted: 01/27/2009] [Indexed: 02/08/2023] Open
Abstract
The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
| | - Ryan L Neff
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
| | - Cathy M Mojzisik
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - David M O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
| | - George H Hinkle
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
- College of Pharmacy, The Ohio State University, Columbus, OH, 43210, USA
| | - Nathan C Hall
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Douglas A Murrey
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Michael V Knopp
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Edward W Martin
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
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Bodendorf MO, Haas V, Laberke HG, Blumenstock G, Wex P, Graeter T. Prognostic value and therapeutic consequences of vascular invasion in non-small cell lung carcinoma. Lung Cancer 2008; 64:71-8. [PMID: 18790545 DOI: 10.1016/j.lungcan.2008.07.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 07/14/2008] [Accepted: 07/15/2008] [Indexed: 11/18/2022]
Abstract
The prognostic relevance of blood vessel invasion (BVI) in non-small cell lung carcinoma (NSCLC) remains controversial, as is the question of whether its finding should influence therapeutic decisions after an R0 resection. One hundred and twelve cases of NSCLC were included in the study. All had been treated by potentially curative surgical resection of the primary tumor and systematic lymphadenectomy. In all cases, lymphatic metastatic spread was at its earliest stage and only one regional lymph node was involved, 27.0+/-8.9 nodes per patient being examined histologically. Most of the cases were pT2 (75.9%) and pN1 (81.3%), and all were MX/M0 and R0. 62.5% were at stage IIB, 25.9% at stage IIIA, and 9.8% at stage IIA. BVI was found in 45.5% of the tumors (V1), and 18.8% exhibited both lymphatic invasion and BVI (L1V1). Local recurrence occurred in 10.7% of the patients, distant metastasis in 24.1%, and both forms of tumor progression simultaneously in a further 7.1%. Thus 31.2% of the patients developed distant metastases by hematogenous spread (to the brain, bones, lung, adrenal, and liver, in descending order of frequency), mostly within two years of surgery. Late metastasis is not typical of NSCLC. Adenocarcinomas showed a strong tendency to be associated with a poorer prognosis than squamous cell carcinomas, probably because of their more frequent involvement of blood vessels. Five-year survival (Kaplan-Meier method) was significantly lower in V1 cases (37.2%) than in V0 cases (56.0%; p = 0.0249). Adjuvant mediastinal radiation in node-positive cases of NSCLC may prevent local recurrence but is unlikely to influence the development of distant metastases. The histological detection of BVI is of prognostic relevance and should be considered for inclusion in the staging criteria and indications for adjuvant chemotherapy.
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Intraoperative sentinel lymph node mapping in stage I non-small cell lung cancer: detection of micrometastases by polymerase chain reaction. Eur J Cardiothorac Surg 2008; 34:181-6. [DOI: 10.1016/j.ejcts.2008.03.059] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 02/18/2008] [Accepted: 03/04/2008] [Indexed: 01/11/2023] Open
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