Intraoperative radioisotope sentinel lymph node mapping in non-small cell lung cancer.
BACKGROUND
Lymph node metastases are the most significant prognostic factor in localized non-small cell lung cancer (NSCLC). Nodal micrometastases may not be detected. Identification of the first nodal drainage site (sentinel node) may improve detection of metastatic nodes. We performed intraoperative Technetium 99m sentinel lymph node (SN) mapping in patients with resectable NSCLC.


METHODS
Fifty-two patients (31 men, 21 women) with resectable suspected NSCLC were enrolled. At thoracotomy, the primary tumor was injected with 2 mCi Tc-99. After dissection, scintographic readings of both the primary tumor and lymph nodes were obtained with a handheld gamma counter. Resection with mediastinal node dissection was performed and findings were correlated with histologic examination.


RESULTS
Seven of the 52 patients did not have NSCLC (5 benign lesions, and 2 metastatic tumors) and were excluded. Forty-five patients had NSCLC completely resected. Mean time from injection of the radionucleide to identification of sentinel nodes was 63 minutes (range 23 to 170). Thirty-seven patients (82%) had a SN identified; 12 (32%) had metastatic disease. 35 of the 37 SNs (94%) were classified as true positive with no metastases found in other intrathoracic lymph nodes without concurrent SN involvement. Two inaccurately identified SNs were encountered (5%). SNs were mediastinal (N2) in 8 patients (22%).


CONCLUSIONS
Intraoperative SN mapping with Tc-99 is an accurate way to identify the first site of potential nodal metastases of NSCLC. This method may improve the precision of pathologic staging and limit the need for mediastinal node dissection in selected patients.
Liptay
M J
MJ
Department of Surgery, Radiation Medicine, Evanston Northwestern Healthcare, Northwestern University Medical School, Illinois 60201, USA. m-liptay@nwu.edu
Masters
G A
GA
Winchester
D J
DJ
Edelman
B L
BL
Garrido
B J
BJ
Hirschtritt
T R
TR
Perlman
R M
RM
Fry
W A
WA
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid
D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid