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Sentinel Lymph Node in Non-Small Cell Lung Cancer: Assessment of Feasibility and Safety by Near-Infrared Fluorescence Imaging and Clinical Consequences. J Pers Med 2022; 13:jpm13010090. [PMID: 36675751 PMCID: PMC9866901 DOI: 10.3390/jpm13010090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
Occult micrometastases can be missed by routine pathological analysis. Mapping of the pulmonary lymphatic system by near-infrared (NIR) fluorescence imaging can identify the first lymph node relay. This sentinel lymph node (SLN) can be analyzed by immunohistochemistry (IHC), which may increase micrometastasis detection and improve staging. This study analyzed the feasibility and safety of identifying SLNs in thoracic surgery by NIR fluorescence imaging in non-small cell lung cancer (NSCLC). This was a prospective, observational, single-center study. Eighty adult patients with suspected localized stage NSCLC (IA1 to IIA) were included between December 2020 and May 2022. All patients received an intraoperative injection of indocyanine green (ICG) directly in the peri tumoural area or by electromagnetic navigational bronchoscopy (ENB). The SLN was then assessed using an infrared fluorescence camera. SLN was identified in 60 patients (75%). Among them, 36 SLNs associated with a primary lung tumor were analyzed by IHC. Four of them were invaded by micrometastases (11.1%). In the case of pN0 SLN, the rest of the lymphadenectomy was cancer free. The identification of SLNs in thoracic surgery by NIR fluorescence imaging seems to be a feasible technique for improving pathological staging.
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Gregor A, Ujiie H, Yasufuku K. Sentinel lymph node biopsy for lung cancer. Gen Thorac Cardiovasc Surg 2020; 68:1061-1078. [PMID: 32661834 DOI: 10.1007/s11748-020-01432-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
Sentinel lymph node biopsy is a technique to identify the first lymph node (or nodes) draining a tumor. The underlying principle is that as the first site of cancer spread, evaluation of the sentinel node will be most predictive for wider nodal involvement. The introduction of sentinel node biopsy revolutionized the surgical management of cutaneous melanoma and breast cancer, becoming a key component in the management of such patients. For over 20 years, thoracic surgeons have similarly worked to apply this technique to lung cancer but have thus far not had the same impact on lung surgery. In this review, we will summarize the ongoing discussions on the role of sentinel node biopsy in lung cancer, the methods for identifying the sentinel node, and the techniques for evaluating the sentinel node specimen. We will also highlight some of the pressing questions investigators should consider when designing a trial for sentinel node mapping. This will clarify the current status of sentinel node biopsy in lung cancer and thus highlight important future directions for research.
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Affiliation(s)
- Alexander Gregor
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada. .,Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
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He Z, Xia Y, Tang S, Chen Y, Chen L. Detection of occult tumor cells in regional lymph nodes is associated with poor survival in pN0 non-small cell lung cancer: a meta-analysis. J Thorac Dis 2016; 8:375-85. [PMID: 27076932 DOI: 10.21037/jtd.2016.02.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND patients of pN0 non-small cell lung cancer (NSCLC) with occult tumor cells (OTCs) in regional lymph nodes (LNs) are reported to have controversial prognostic outcomes. METHOD We pooled pN0 NSCLC patients with OTCs in LNs and compared with those without OTCs. Patient characteristics, hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and/or disease-free survival (DFS) were analyzed. HR greater than 1 conferred an increased hazard for patients with OTCs. RESULTS Eighteen articles were finally enrolled in the meta-analysis and 15 studies provided sufficient data for extracting HRs for OS, resulting to 5 articles available for DFS analysis. The combined HRs of OS was 2.22 (95% CI, 1.87 to 2.64) and 2.4 (95% CI, 1.71 to 3.36) for analysis of DFS. The similar trend was obtained in the subgroup analyses regarding detection methods and study type. Interestingly, even in the analysis of mean numbers of LNs dissection (MLND) intraoperatively, both subgroups (LNs/Pts. <12 and ≥12) illustrated significant HRs of OS (HR: 3.13, 95% CI, 2.17 to 4.52 in LNs/Pts. <12 subgroup and HR: 2.09, 95% CI, 1.63 to 2.68 in LNs/Pts. ≥12). The combined HR of OS in this section was 2.37 (95% CI, 1.63 to 2.68). No publication bias was detected in all the meta-analysis sections. The prognosis of patients with OTCs is inferior to those without OTCs in the terms of OS and DFS regardless of detection methods, study types and MLND. CONCLUSIONS The prognosis of patients with OTCs is inferior to those without OTCs in the terms of OS and DFS regardless of detection methods, study types and MLND.
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Affiliation(s)
- Zhicheng He
- 1 Department of Thoracic Surgery, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210029, China
| | - Yang Xia
- 1 Department of Thoracic Surgery, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210029, China
| | - Shaowen Tang
- 1 Department of Thoracic Surgery, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210029, China
| | - Yijiang Chen
- 1 Department of Thoracic Surgery, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210029, China
| | - Liang Chen
- 1 Department of Thoracic Surgery, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210029, China
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Wada H, Hirohashi K, Anayama T, Nakajima T, Kato T, Chan HHL, Qiu J, Daly M, Weersink R, Jaffray DA, Irish JC, Waddell TK, Keshavjee S, Yoshino I, Yasufuku K. Minimally invasive electro-magnetic navigational bronchoscopy-integrated near-infrared-guided sentinel lymph node mapping in the porcine lung. PLoS One 2015; 10:e0126945. [PMID: 25993006 PMCID: PMC4438870 DOI: 10.1371/journal.pone.0126945] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 04/09/2015] [Indexed: 02/05/2023] Open
Abstract
Background The use of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) for sentinel lymph node (SN) mapping has been investigated in lung cancer; however, this has not been fully adapted for minimally invasive surgery (MIS). The aim of our study was to develop a minimally invasive SN mapping integrating pre-operative electro-magnetic navigational bronchoscopy (ENB)-guided transbronchial ICG injection and intraoperative NIR thoracoscopic imaging. Methods A NIR thoracoscope was used to visualize ICG fluorescence. ICG solutions in a 96-well plate and ex vivo porcine lungs were examined to optimize ICG concentrations and injection volumes. Transbronchial ICG injection (n=4) was assessed in comparison to a traditional transpleural approach (n=3), where after thoracotomy an ICG solution (100μL at 100μg/mL) was injected into the porcine right upper lobe for SN identification. For further translation into clinical use, transbronchial ICG injection prior to thoracotomy followed by NIR thoracoscopic imaging was validated (n=3). ENB was used for accurate targeting in two pigs with a pseudo-tumor. Results The ICG fluorescence at 10 μg/mL was the brightest among various concentrations, unchanged by the distance between the thoracoscope and ICG solutions. Injected ICG of no more than 500μL showed a localized fluorescence area. All 7 pigs showed a bright paratracheal lymph node within 15 minutes post-injection, with persistent fluorescence for 60 minutes. The antecedent transbronchial ICG injection succeeded in SN identification in all 3 cases at the first thoracoscopic inspection within 20 minutes post-injection. The ENB system allowed accurate ICG injection surrounding the pseudo-tumors. Conclusions ENB-guided ICG injection followed by NIR thoracoscopy was technically feasible for SN mapping in the porcine lung. This promising platform may be translated into human clinical trials and is suited for MIS.
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Affiliation(s)
- Hironobu Wada
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kentaro Hirohashi
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Takashi Anayama
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Takahiro Nakajima
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuya Kato
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Harley H. L. Chan
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael Daly
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Robert Weersink
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - David A. Jaffray
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C. Irish
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas K. Waddell
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- * E-mail:
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Imai K, Kawaharada Y, Ogawa JI, Saito H, Kudo S, Takashima S, Saito Y, Atari M, Ito A, Terata K, Yoshino K, Sato Y, Motoyama S, Minamiya Y. Development of a New Magnetometer for Sentinel Lymph Node Mapping Designed for Video-Assisted Thoracic Surgery in Non-Small Cell Lung Cancer. Surg Innov 2015; 22:401-5. [PMID: 25940853 DOI: 10.1177/1553350615585421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We previously developed a method for sentinel lymph node (SLN) mapping in non-small cell lung cancer (NSCLC), based on the magnetic force produced by a magnetite tracer already approved for use as a contrast material for magnetic resonance imaging. However, it is difficult to use that technique with video-assisted thoracic surgery (VATS) because the sensing element of the magnetometer is large and thick. The purpose of the present study was to develop a smaller, thinner VATS-compatible magnetometer. METHODS The tracer employed was Ferucarbotran, a colloidal solution of superparamagnetic iron oxide coated with carbodextran. Fifteen patients with clinical stage I NSCLC were enrolled, and each received 1.6 mL of Ferucarbotran, injected intraoperatively at 5 points around the tumor. The magnetic force within the sampling lymph nodes was measured using the new VATS-compatible magnetometer. RESULTS SLNs were detected in 11 (73.3%) of the 15 patients using the VATS-compatible magnetometer. The average number of SLNs identified per patient was 1.8 (range 0-4). No complications related to the SLN detection method were observed. CONCLUSIONS The new VATS-compatible magnetometer appears to have substantial advantages over techniques using a radioisotope and our earlier magnetometer, as it can be inserted through the small VATS port site.
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Affiliation(s)
- Kazuhiro Imai
- Akita University Graduate School of Medicine, Akita, Japan
| | | | - Jun-Ichi Ogawa
- Akita University Graduate School of Medicine, Akita, Japan
| | - Hajime Saito
- Akita University Graduate School of Medicine, Akita, Japan
| | - Satoshi Kudo
- Akita University Graduate School of Medicine, Akita, Japan
| | | | | | - Maiko Atari
- Akita University Graduate School of Medicine, Akita, Japan
| | - Aki Ito
- Akita University Graduate School of Medicine, Akita, Japan
| | - Kaori Terata
- Akita University Graduate School of Medicine, Akita, Japan
| | - Kei Yoshino
- Akita University Graduate School of Medicine, Akita, Japan
| | - Yusuke Sato
- Akita University Graduate School of Medicine, Akita, Japan
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Detterbeck FC, Postmus PE, Tanoue LT. The stage classification of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e191S-e210S. [PMID: 23649438 DOI: 10.1378/chest.12-2354] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The current Lung Cancer Stage Classification system is the seventh edition, which took effect in January 2010. This article reviews the definitions for the TNM descriptors and the stage grouping in this system.
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Affiliation(s)
| | - Pieter E Postmus
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Lynn T Tanoue
- Section of Pulmonary and Critical Care Medicine, Yale School of Medicine, New Haven, CT
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The role of SHP-1 promoter 2 hypermethylation detection of lymph node micrometastasis in resectable stage I non-small cell lung cancer as a prognostic marker of disease recurrence. Int J Clin Oncol 2013; 19:586-92. [DOI: 10.1007/s10147-013-0590-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/17/2013] [Indexed: 02/02/2023]
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Accuracy of sentinel node biopsy in the staging of non-small cell lung carcinomas: systematic review and meta-analysis of the literature. Lung Cancer 2013; 80:5-14. [PMID: 23352034 DOI: 10.1016/j.lungcan.2013.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/28/2012] [Accepted: 01/04/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Not all patients with non-small cell lung carcinoma (NSCLC) have mediastinal lymph node involvement and development of less invasive methods for evaluating mediastinal lymph nodes is important. Sentinel node biopsy has been used for NSCLC since 1999 to decrease the need for mediastinal lymph node dissection. In this review, we searched the literature in this regard and reported the results in a meta-analysis format. METHODS Medline, SCOPUS, and ISI web of knowledge were searched using: "(lung AND sentinel)" with no date or language limit. Any study with more than 5 patients and enough information to calculate detection rate and sensitivity was included. RESULTS Overall 47 and 43 studies (including subgroups) had the criteria for detection rate and sensitivity pooling respectively. Pooled detection rate was 80.6% [76.8-84%] and pooled sensitivity was 87% [83-90%]. Using radiotracers or both radiotracers and dyes had higher detection rate and sensitivity compared to dye alone. Among studies using radiotracers, highest detection rate was in intra-operative peri-tumoral injection group and highest sensitivity was in peri-tumoral pre-operative injection group. Emerging methods of sentinel node surgery including magnetic materials, fluorescent dyes, CT contrast agents, and carbon nano-particles had promising results. CONCLUSIONS Sentinel node mapping using radiotracers is a feasible technique for mediastinal lymph node staging of N0 NSCLC patients. Alternative methods of sentinel node mapping are promising and warrant further studies.
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Toda H, Minamiya Y, Kagaya M, Nanjo H, Akagami Y, Saito H, Ito M, Konno H, Motoyama S, Ogawa J. A novel immunohistochemical staining method allows ultrarapid detection of lymph node micrometastases while conserving antibody. Acta Histochem Cytochem 2011; 44:133-9. [PMID: 21753859 PMCID: PMC3130145 DOI: 10.1267/ahc.11006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 04/18/2011] [Indexed: 11/22/2022] Open
Abstract
We developed a novel ultrarapid immunohistochemical staining method in which an AC electric field is used to facilitate detection of tumor cells. Frozen sections of non-small cell lung cancer in lymph nodes were fixed in acetone for 2 min, after which they were incubated for 2 min with an anti-pancytokeratin antibody cocktail and then with EnVision(TM) complex under an alternating current (AC) electric field. The sections were then incubated with a chromogen (3,3'diaminobenzidine) for 3 min and counterstained with hematoxylin. This method enabled detection of tumor cells in frozen sections in less than 15 min. In addition, we were able to reduce the amount of antibody used by more than 90% when the sections were incubated under the AC electric field for a longer period. This method could be a useful tool for frozen section diagnosis and research. Furthermore, with this method the cost of immunohistochemical staining can be reduced.
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Affiliation(s)
- Hiroshi Toda
- Department of Thoracic Surgery, Akita University Graduate School of Medicine
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine
| | | | - Hiroshi Nanjo
- Division of Clinical Pathology, Akita University Hospital
| | | | - Hajime Saito
- Department of Thoracic Surgery, Akita University Graduate School of Medicine
| | - Manabu Ito
- Department of Thoracic Surgery, Akita University Graduate School of Medicine
| | - Hayato Konno
- Department of Thoracic Surgery, Akita University Graduate School of Medicine
| | - Satoru Motoyama
- Department of Thoracic Surgery, Akita University Graduate School of Medicine
| | - Junichi Ogawa
- Department of Thoracic Surgery, Akita University Graduate School of Medicine
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Detterbeck FC, Boffa DJ, Tanoue LT, Wilson LD. Details and Difficulties Regarding the New Lung Cancer Staging System. Chest 2010; 137:1172-80. [DOI: 10.1378/chest.09-2626] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kim AW. Lymph Node Drainage Patterns and Micrometastasis in Lung Cancer. Semin Thorac Cardiovasc Surg 2009; 21:298-308. [PMID: 20226342 DOI: 10.1053/j.semtcvs.2009.11.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2009] [Indexed: 11/11/2022]
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