Intraoperative, radio-guided sentinel lymph node mapping in 110 nonsmall cell lung cancer patients.
BACKGROUND
Sentinel lymph node identification has been tested in lung cancer patients with conflicting results. The present study was designed to assess the sensitivity, negative predictive value, and accuracy of intraoperative sentinel lymph node mapping by means of a radio-guided method in patients with nonsmall cell lung cancer to find the most appropriate definition of sentinel lymph node and to evaluate the usefulness of different particle sizes of radiocolloid.


METHODS
One hundred ten patients with clinically N0 nonsmall cell lung cancer were enrolled in the pilot study of intraoperative sentinel node identification. Four quadrants of the peritumoral tissue were injected with 2 mL of 0.5 mCi technetium-99m suspension. Four radiocolloids of different particle size were used. After complete lymphadenectomy, all resected lymph nodes were examined with hematoxylin-eosin staining. All sentinel nodes negative for metastases by routine staining were searched further for metastatic deposits with both serial sections and immunohistochemistry for cytokeratins.


RESULTS
The radio-guided method had a high identification rate, a high sensitivity, and a high negative predictive value (100%, 87%, and 93%, respectively) when immunohistochemistry was considered. When standard hematoxylin and eosin staining was applied, sensitivity and negative predictive value of sentinel lymph node labeling was lower (74% and 89%, respectively). No significant differences were found in either the sensitivity or negative predictive value among the colloid solutions of different particle size used in radio labeling, although smaller particles have shown a tendency to produce better results.


CONCLUSIONS
The radio-guided technique provides efficient sentinel lymph node identification in lung cancer. Further studies are warranted to confirm the clinical utility of this strategy.
Rzyman
Witold
W
Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland. wrzyman@amg.gda.pl
Hagen
Ole M
OM
Dziadziuszko
Rafal
R
Kobierska-Gulida
Grazyna
G
Karmolinski
Andrzej
A
Lothe
Inger M
IM
Babovic
Almira
A
Murawski
Maciej
M
Paleczka
Waldemar
W
Jastrzebski
Tomasz
T
Kopacz
Andrzej
A
Jassem
Jacek
J
Lass
Piotr
P
Skokowski
Jaroslaw
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D003657:Decision Making; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007633:Keratins / Q000032:analysis; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000032:analysis; D009367:Neoplasm Staging / Q000379:methods; D010316:Particle Size; D010865:Pilot Projects; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin; D013671:Technetium Tc 99m Sulfur Colloid
D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C512413:nanocis; C083602:technetium Tc 99m nanocolloid; D013671:Technetium Tc 99m Sulfur Colloid; D007633:Keratins