Ex-vivo exploration of an endobronchial sentinel lymph node procedure in lung cancer for optimizing workflow and evaluating feasibility of novel imaging tools.

Autor:	Ter Woerds DKM; Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands., Verhoeven RLJ; Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands., van der Heide SM; Department of Cardio-Thoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Verhagen AFTM; Department of Cardio-Thoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Aarntzen EHJG; Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands., van der Heijden EHFM; Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2023 Feb 28; Vol. 15 (2), pp. 291-299. Date of Electronic Publication: 2023 Feb 13.
DOI:	10.21037/jtd-22-984
Abstrakt:	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 99m Tc-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 99m Tc (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. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-984/coif). RLJV reports unrestricted research grants from Philips Medical, Astra Zeneca, Pentax Medical and Johnson & Johnson, consulting fees from Johnson & Johnson and Intuitive Surgical, speaker fees from Medtronic, Travel arrangements from Johnson & Johnson and Intuitive Surgical, is a board member of the Dutch Society of Technical Physicians (NVvTG) and has patents issued, pending and planned in the field of advanced and navigation bronchoscopy; EHFMvdH reports unrestricted research grants from Philips Medical, Astra Zeneca, Pentax Medical and Johnson & Johnson, consulting fees from Johnson & Johnson and Intuitive Surgical, speaker fees from Janssen-Cilag and Pentax Medical, Travel arrangements from Johnson & Johnson and Intuitive Surgical, is a board member of European Association for Bronchology and Interventional Pulmonology (ECBIP) and a board of regents member of the World Association for Bronchology and Interventional Pulmonology (WABIP) and has patents issued, pending and planned in the field of advanced and navigation bronchoscopy. The other authors have no conflicts of interest to declare. (2023 Journal of Thoracic Disease. All rights reserved.)
Databáze:	MEDLINE
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