A novel technique for tumor localization and targeted lymphatic mapping in early-stage lung cancer.

Autor:	Hachey KJ; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass., Digesu CS; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass., Armstrong KW; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass., Gilmore DM; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn., Khullar OV; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga., Whang B; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass., Tsukada H; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass., Colson YL; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass. Electronic address: ycolson@partners.org.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2017 Sep; Vol. 154 (3), pp. 1110-1118. Date of Electronic Publication: 2017 Feb 10.
DOI:	10.1016/j.jtcvs.2016.12.058
Abstrakt:	Objective: 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). Methods: 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. Results: 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. Conclusions: 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. (Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu