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Ter Woerds DKM, Verhoeven RLJ, van der Heide SM, Verhagen AFTM, Aarntzen EHJG, van der Heijden EHFM. Ex-vivo exploration of an endobronchial sentinel lymph node procedure in lung cancer for optimizing workflow and evaluating feasibility of novel imaging tools. J Thorac Dis 2023; 15:291-299. [PMID: 36910083 PMCID: PMC9992569 DOI: 10.21037/jtd-22-984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/09/2022] [Indexed: 02/15/2023]
Abstract
Background Early-stage lung cancer is treated with curative intent by surgery or radiotherapy. However, upstaging is frequently seen after surgery in clinical N0 lung cancer patients, and despite curative intent, 2-year recurrence rates of 9-28% are reported. A sentinel lymph node (SLN) procedure could improve the staging accuracy. We explored the feasibility of performing a navigation bronchoscopy based SLN procedure in human ex-vivo lung cancer specimens to optimize procedural parameters and assess a novel injection tool. Methods Ten lung resection specimens were included and allocated to either peri- or intratumoral injection of a tracer combining 99mTc-nanocolloid and indocyanine green (ICG) while varying the injection volume. A Pioneer Plus catheter with a pre-angulated 24G needle and an ultrasound (US)-element was used to perform real-time US guided transbronchial injections at multiple locations. Thereafter, single photon emission computed tomography/computed tomography (SPECT/CT)-scanning was performed to image injection depots and to assess their location relative to the tumor. Results An average volume of 0.7 mL (range, 0.3-1.2 mL) with an average activity of 89.5 MBq 99mTc (range, 35.4-188.0 MBq) was injected. Intratumoral injections in non-solid and solid tumors were successful in 100% and 64.3% respectively, while 100% of peritumoral injections in solid tumors were successful. The US-element of the catheter allowed real-time imaging and was able to visualize all tumors and 67.4% of all injections. SPECT/CT-scanning visualized 76.7% of the injection depots. Conclusions A navigation bronchoscopy mediated SLN procedure seems technically feasible. The Pioneer Plus is a suitable catheter to place tracer depots at multiple intra-/peri-tumoral sites, while receiving real-time feedback on the needle localization in relation to the tumor. The next step of in-vivo injections will determine if tracer drainage to the SLN can also be detected on pre- and per-operative imaging.
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Affiliation(s)
- Desi K M Ter Woerds
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roel L J Verhoeven
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefan M van der Heide
- Department of Cardio-Thoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ad F T M Verhagen
- Department of Cardio-Thoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik H J G Aarntzen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
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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: 7] [Impact Index Per Article: 2.3] [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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Ye Q, Singh S, Qian PR, Guo NL. Immune-Omics Networks of CD27, PD1, and PDL1 in Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:4296. [PMID: 34503105 PMCID: PMC8428355 DOI: 10.3390/cancers13174296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 01/03/2023] Open
Abstract
To date, there are no prognostic/predictive biomarkers to select chemotherapy, immunotherapy, and radiotherapy in individual non-small cell lung cancer (NSCLC) patients. Major immune-checkpoint inhibitors (ICIs) have more DNA copy number variations (CNV) than mutations in The Cancer Genome Atlas (TCGA) NSCLC tumors. Nevertheless, CNV-mediated dysregulated gene expression in NSCLC is not well understood. Integrated CNV and transcriptional profiles in NSCLC tumors (n = 371) were analyzed using Boolean implication networks for the identification of a multi-omics CD27, PD1, and PDL1 network, containing novel prognostic genes and proliferation genes. A 5-gene (EIF2AK3, F2RL3, FOSL1, SLC25A26, and SPP1) prognostic model was developed and validated for patient stratification (p < 0.02, Kaplan-Meier analyses) in NSCLC tumors (n = 1163). A total of 13 genes (COPA, CSE1L, EIF2B3, LSM3, MCM5, PMPCB, POLR1B, POLR2F, PSMC3, PSMD11, RPL32, RPS18, and SNRPE) had a significant impact on proliferation in 100% of the NSCLC cell lines in both CRISPR-Cas9 (n = 78) and RNA interference (RNAi) assays (n = 92). Multiple identified genes were associated with chemoresponse and radiotherapy response in NSCLC cell lines (n = 117) and patient tumors (n = 966). Repurposing drugs were discovered based on this immune-omics network to improve NSCLC treatment.
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Affiliation(s)
- Qing Ye
- West Virginia University Cancer Institute, West Virginia University, Morgantown, WV 26506, USA; (Q.Y.); (S.S.); (P.R.Q.)
- Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV 26506, USA
| | - Salvi Singh
- West Virginia University Cancer Institute, West Virginia University, Morgantown, WV 26506, USA; (Q.Y.); (S.S.); (P.R.Q.)
- Lane Department of Computer Science and Electrical Engineering, West Virginia University, Morgantown, WV 26506, USA
| | - Peter R. Qian
- West Virginia University Cancer Institute, West Virginia University, Morgantown, WV 26506, USA; (Q.Y.); (S.S.); (P.R.Q.)
| | - Nancy Lan Guo
- West Virginia University Cancer Institute, West Virginia University, Morgantown, WV 26506, USA; (Q.Y.); (S.S.); (P.R.Q.)
- Department of Occupational and Environmental Health Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
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Sun WYL, Dang JT, Modasi A, Nasralla A, Switzer NJ, Birch D, Turner SR, Karmali S. Diagnostic accuracy of sentinel lymph node biopsy using indocyanine green in lung cancer: a systematic review and meta-analysis. Gen Thorac Cardiovasc Surg 2020; 68:905-913. [PMID: 32557077 DOI: 10.1007/s11748-020-01400-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The use of sentinel lymph node biopsy (SLNB) has been gaining popularity with the emergence of indocyanine green (ICG) fluorescence imaging. We aimed to systematically review the literature and perform a meta-analysis on the diagnostic accuracy of SLNB using ICG for lung cancer. METHODS A comprehensive search of MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library using search terms "lung/pulmonary" AND "tumor/carcinoma/cancer/neoplasm/adenocarcinoma/malignancy/squamous/carcinoid" AND "indocyanine green" was completed in June 2018. Articles were selected based on the following inclusion criteria: (1) diagnostic accuracy study design; (2) ICG injected at the tumor site with near-infrared fluorescence imaging identification of sentinel lymph nodes; (3) lymphadenectomy or sampling was performed as the gold standard. RESULTS Eight primary studies were included with a total of 366 patients. 43.0% of patients were females and the mean tumor size was 2.3 cm. Sentinel lymph nodes were identified with ICG in 251 patients, yielding a pooled identification rate of 0.83 (0.67-0.94). A meta-analysis of seven studies computed a diagnostic odds ratio, sensitivity, and specificity of 177.6 (45.6-691.1), 0.85 (0.71-0.94), and 1.00 (0.98-1.00), respectively. The summary receiver operator characteristic demonstrated an area under the curve of 0.963 (SE = 0.038) and a Q* of 0.91 (SE = 0.057). CONCLUSION Our review found suboptimal results for the diagnostic accuracy of SLNB using ICG and must be improved before routine clinical use. Further research is required to develop a robust protocol for the use SLNB with ICG for lung cancer.
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Affiliation(s)
- Warren Y L Sun
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada.
| | - Jerry T Dang
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada
| | - Aryan Modasi
- Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
| | - Awrad Nasralla
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada
| | - Noah J Switzer
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
| | - Daniel Birch
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
| | - Simon R Turner
- Division of Thoracic Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Division of General Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 ST NW, Edmonton, AB, 2G2 T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation, Edmonton, AB, Canada
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