Successful migration of three tracers without identification of sentinel nodes during intraoperative lymphatic mapping for non-small cell lung cancer.
Prospective comparative evaluation of patent V blue, fluorescein and (99m)TC-nanocolloids for intraoperative sentinel lymph node (SLN) mapping during surgery for non-small cell lung cancer (NSCLC). Ten patients with peripherally localised clinical stage I NSCLC underwent thoracotomy and peritumoral subpleural injection of 2 ml of patent V blue dye, 1 ml of 10% fluorescein and 1ml of (99m)Tc-nanocolloids (0.4 mCi). The migration and spatial distribution pattern of the tracers was assessed by direct visualisation (patent V blue), visualisation of fluorescence signalling by a lamp of Wood (fluorescein) and radioactivity counting with a hand held gamma-probe ((99m)Tc-nanocolloids). Lymph nodes at interlobar (ATS 11), hilar (ATS 10) and mediastinal (right ATS 2,4,7; left ATS 5,6,7) levels were systematically assessed every 10 min up to 60 min after injection, followed by lobectomy and formal lymph node dissection. Successful migration from the peritumoral area to the mediastinum was observed for all three tracers up to 60 min after injection. The interlobar lympho-fatty tissue (station ATS 11) revealed an early and preferential accumulation of all three tracers for all tumours assessed and irrespective of the tumour localisation. However, no preferential accumulation in one or two distinct lymph nodes was observed up to 60 min after injection for all three tracers assessed. Intraoperative SLN mapping revealed successful migration of the tracers from the site of peritumoral injection to the mediastinum, but in a diffuse pattern without preferential accumulation in sentinel lymph nodes.
Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland.
Antoine
A
Meyer
Cai
C
Cheng
Christian
C
Antonescu
Edgardo
E
Pezzetta
Angelika
A
Bischof-Delaloye
Hans-Beat
HB
Ris
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D019793:Fluorescein / Q000008:administration & dosage; D005456:Fluorescent Dyes / Q000008:administration & dosage; D006801:Humans; D015552:Injections, Intralesional; D007430:Intraoperative Care; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D018579:Patient Selection; D011013:Pneumonectomy; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012394:Rosaniline Dyes / Q000008:administration & dosage; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
D005456:Fluorescent Dyes; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid; C008769:sulfan blue; D019793:Fluorescein