title: A novel technique for tumor localization and targeted lymphatic mapping in early-stage lung cancer.
abstract: To investigate safety and feasibility of navigational bronchoscopy (NB)-guided near-infrared (NIR) localization of small, ill-defined lung lesions and sentinel lymph nodes (SLN) for accurate staging in patients with non-small cell lung cancer (NSCLC).
  
  
  
  Patients with known or suspected stage I NSCLC were enrolled in a prospective pilot trial for lesion localization and SLN mapping via NB-guided NIR marking. Successful localization, SLN detection rates, histopathologic status of SLN versus overall nodes, and concordance to initial clinical stage were measured. Ex vivo confirmation of NIR+SLNs and adverse events were recorded.
  
  
  
  Twelve patients underwent NB-guided marking with indocyanine green of lung lesions ranging in size from 0.4 to 2.2 cm and located 0.1 to 3 cm from the pleural surface. An NIR+"tattoo" was identified in all cases. Ten patients were diagnosed with NSCLC and 9 SLNs were identified in 8 of the 10 patients, resulting in an 80% SLN detection rate. SLN pathologic status was 100% sensitive and specific for overall nodal status with no false-negative results. Despite previous nodal sampling, one patient was found to have metastatic disease in the SLN alone, a 12.5% rate of disease upstaging with NIR SLN mapping. SLN were detectable for up to 3 hours, allowing time for obtaining a tissue diagnosis and surgical resection. There were no adverse events associated with NB-labeling or indocyanine green dye itself.
  
  
  
  NB-guided NIR lesion localization and SLN identification was safe and feasible. This minimally invasive image-guided technique may permit the accurate localization and nodal staging of early stage lung cancers.
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Krista J
authors.initials: KJ
authors.lastname: Hachey
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Digesu
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Armstrong
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
authors.forename: Denis M
authors.initials: DM
authors.lastname: Gilmore
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Onkar V
authors.initials: OV
authors.lastname: Khullar
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Brian
authors.initials: B
authors.lastname: Whang
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Tsukada
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass. Electronic address: ycolson@partners.org.
authors.forename: Yolonda L
authors.initials: YL
authors.lastname: Colson
mesh_terms: D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000601:surgery; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D019265:Spectroscopy, Near-Infrared; D020775:Thoracic Surgery, Video-Assisted
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: lung cancer; navigational bronchoscopy; near-infrared; sentinel lymph node; tumor localization