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01-03-2012 | Thoracic Oncology

Sentinel Node Navigation Surgery by Thoracoscopic Fluorescence Imaging System and Molecular Examination in Non-Small Cell Lung Cancer

Authors: Shin-ichi Yamashita, MD, Keita Tokuishi, MD, Michiyo Miyawaki, MD, Kentaro Anami, MD, Toshihiko Moroga, MD, Shinsuke Takeno, MD, Masao Chujo, MD, Satoshi Yamamoto, MD, Katsunobu Kawahara, MD

Published in: Annals of Surgical Oncology | Issue 3/2012

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.

Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.PubMedCrossRef

Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol. 1993;2:335–9.PubMedCrossRef

Liptay MJ. Sentinel node mapping in lung cancer: the Holy Grail? Ann Thorac Surg. 2008;85:S778–9.PubMedCrossRef

Little AG, DeHoyos A, Kirgan DM, Arcomano TR, Murray KD. Intraoperative lymphatic mapping for non-small cell lung cancer: the sentinel node technique. J Thorac Cardiovasc Surg. 1999;117:220–4.PubMedCrossRef

Liptay MJ, Masters GA, Winchester DJ, et al. Intraoperative radioisotope sentinel lymph node mapping in non-small cell lung cancer. Ann Thorac Surg. 2000;70:384–9.PubMedCrossRef

Nomori H, Horio H, Naruke T, Orikasa H, Yamazaki K, Suemasu K. Use of technetium-99 m tin colloid for sentinel lymph node identification in non-small cell lung cancer. J Thorac Cardiovasc Surg. 2002;124:486–92.PubMedCrossRef

Liptay MJ, D’amico TA, Nwogu C, et al.; Thoracic Surgery Subcommittee of the Cancer and Leukemia Group B. 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.PubMedCrossRef

Yamashita S, Tokuishi K, Anami K, et al. Video-assisted thoracoscopic indocyanine green fluorescence imaging system shows sentinel lymph nodes in non-small cell lung cancer. J Thorac Cardiovasc Surg. 2011;141:141–4.PubMedCrossRef

Aarskog NK, Vedeler CA. Real-time quantitative polymerase chain reaction. A new method that detects both the peripheral myelin protein 22 duplication in Charcot-Marie-Tooth type 1A disease and the peripheral myelin protein 22 deletion in hereditary neuropathy with liability to pressure palsies. Hum Genet. 2000;107:494–8.PubMedCrossRef

10.

Allen MS, Darling GE, Pechet TT, et al.; ACOSOG Z0030 Study Group. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006;81:1013–9.PubMedCrossRef

11.

Miyashiro I, Miyoshi N, Hiratsuka M, et al. Detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging: comparison with infrared imaging. Ann Surg Oncol. 2008;15:1640–3.PubMedCrossRef

12.

Troyan SL, Kianzad V, Gibbs-Strauss SL, et al. The FLARE intraoperative near-infrared fluorescence imaging system: a first-in-human clinical trial in breast cancer sentinel lymph node mapping. Ann Surg Oncol. 2009;16:2943–52.PubMedCrossRef

13.

Tsujino Y, Mizumoto K, Matsuzaka Y, Niihara H, Morita E. Fluorescence navigation with indocyanine green for detecting sentinel nodes in extramammary Paget’s disease and squamous cell carcinoma. J Dermatol. 2009;36:90–4.PubMedCrossRef

14.

Caesar J, Shaldon S, Chiandussi L, Guevara L, Sherlock S. The use of indocyanine green in the measurement of hepatic blood flow and as a test of hepatic function. Clin Sci. 1961;21:43–57.PubMed

15.

Motomura K, Inaji H, Komoike Y, et al. Sentinel node biopsy in breast cancer patients with clinically negative lymph nodes. Breast Cancer. 1999;6:259–62.PubMedCrossRef

16.

Sanidas EE, de Bree E, Tsiftsis DD. How many cases are enough for accreditation in sentinel lymph node biopsy in breast cancer? Am J Surg. 2003;185:202–10.PubMedCrossRef

17.

Liptay MJ, Grondin SC, Fry WA, et al. Intraoperative sentinel lymph node mapping in non-small-cell lung cancer improves detection of micrometastases. J Clin Oncol. 2002;20:1984–8.PubMedCrossRef

18.

Minamiya Y, Ito M, Hosono Y, et al. Subpleural injection of tracer improves detection of mediastinal sentinel lymph nodes in non-small cell lung cancer. Eur J Cardiothorac Surg. 2007;32:770–5.PubMedCrossRef

19.

Melfi FM, Lucchi M, Davini F, et al. 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.PubMedCrossRef

Title: Sentinel Node Navigation Surgery by Thoracoscopic Fluorescence Imaging System and Molecular Examination in Non-Small Cell Lung Cancer
Authors: Shin-ichi Yamashita, MD
Keita Tokuishi, MD
Michiyo Miyawaki, MD
Kentaro Anami, MD
Toshihiko Moroga, MD
Shinsuke Takeno, MD
Masao Chujo, MD
Satoshi Yamamoto, MD
Katsunobu Kawahara, MD
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 3/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-011-2145-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sentinel Node Navigation Surgery by Thoracoscopic Fluorescence Imaging System and Molecular Examination in Non-Small Cell Lung Cancer

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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