Intraoperative Sentinel Lymph Node Mapping in Non–Small-Cell Lung Cancer Improves Detection of Micrometastases
| Autor: | Sean C. Grondin, William G. Watkin, Carol Knop, Willard A. Fry, Gregory A. Masters, Reid M Perlman, Doreine Carson, Chris Pozdol, Michael J. Liptay |
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| Rok vydání: | 2002 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Lung Neoplasms Sentinel lymph node Metastasis Intraoperative Period Carcinoma Non-Small-Cell Lung medicine Carcinoma Humans Prospective Studies Radionuclide Imaging Lung cancer Lymph node Aged Neoplasm Staging Sentinel Lymph Node Biopsy business.industry Micrometastasis Middle Aged medicine.disease Primary tumor medicine.anatomical_structure Oncology Lymphatic Metastasis Technetium Tc 99m Sulfur Colloid Feasibility Studies Female Lymph Nodes Radiology Lymph Radiopharmaceuticals business |
| Zdroj: | Journal of Clinical Oncology. 20:1984-1988 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | PURPOSE: Lymph node metastases are the most significant prognostic factor in localized non–small-cell lung cancer (NSCLC). Nodal micrometastases may not be detected with current standard histologic methods. We performed intraoperative technetium-99m (99mTc) sentinel lymph node (SN) mapping in patients with resectable NSCLC. This study aimed to identify the first station of nodal drainage of operable lung cancers. Serial section histology and immunohistochemistry were used to validate the SN and to identify the presence of micrometastatic disease.PATIENTS AND METHODS: One hundred patients with potentially resectable suspected NSCLC were enrolled. At thoracotomy, the primary tumor was injected with 0.25 to 2 mCi99mTc. Intraoperative scintigraphic readings of both the primary tumor and lymph nodes were obtained with a hand-held gamma counter. Anatomic resection with a mediastinal node dissection was then performed.RESULTS: Nine of the 100 patients did not have NSCLC (seven benign lesions and two metastatic tumors) and were excluded. Seventy-eight (86%) of 91 patients had a SN identified and a complete resection. Sixty-nine (88.5%) out of the 78 SNs were classified as true-positive with no metastases found in other intrathoracic lymph nodes without concurrent SN involvement. In nine patients, the SN was the only positive node. In seven of these nine patients, the SN was found to harbor only micrometastatic disease.CONCLUSION: Intraoperative SN mapping with99mTc is an accurate way to identify the first site of lymphatic tumor drainage in NSCLC. This method may also improve the precision of pathologic staging. |
| Databáze: | OpenAIRE |
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