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Ann Thorac Surg 2006;82:237-242
© 2006 The Society of Thoracic Surgeons

Original article: General thoracic

Intraoperative, Radio-Guided Sentinel Lymph Node Mapping in 110 Nonsmall Cell Lung Cancer Patients

Witold Rzyman, MD, PhD a , * , Ole M. Hagen, MD f , Rafal Dziadziuszko, MD, PhD b , Grazyna Kobierska-Gulida, MD, PhD c , Andrzej Karmolinski, MD, PhD c , Inger M. Lothe, MD, PhD g , Almira Babovic, MD h , Maciej Murawski, MD a , Waldemar Paleczka, MD a , Tomasz Jastrzebski, MD, PhD d , Andrzej Kopacz, MD, PhD d , Jacek Jassem, MD, PhD b , Piotr Lass, MD, PhD e , Jaroslaw Skokowski, MD, PhD a

a Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
b Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
c Department of Pathology, Medical University of Gdansk, Gdansk, Poland
d Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
e Department of Nuclear Medicine, Medical University of Gdansk, Gdansk, Poland
f Department of Thoracic Surgery, Ullevaal University Hospital, Oslo, Norway
g Department of Pathology, Ullevaal University Hospital, Oslo, Norway
h Department of Nuclear Medicine, Ullevaal University Hospital, Oslo, Norway

Accepted for publication January 26, 2006.

* Address correspondence to Dr Rzyman, Department of Thoracic Surgery, Medical University of Gdansk, 7 Debinki St, Gdansk, 80-211 Poland (Email: wrzyman{at}amg.gda.pl).

BACKGROUND: Sentinel lymph node identification has been tested in lung cancer patients with conflicting results. The present study was designed to assess the sensitivity, negative predictive value, and accuracy of intraoperative sentinel lymph node mapping by means of a radio-guided method in patients with nonsmall cell lung cancer to find the most appropriate definition of sentinel lymph node and to evaluate the usefulness of different particle sizes of radiocolloid.

METHODS: One hundred ten patients with clinically N0 nonsmall cell lung cancer were enrolled in the pilot study of intraoperative sentinel node identification. Four quadrants of the peritumoral tissue were injected with 2 mL of 0.5 mCi technetium-99m suspension. Four radiocolloids of different particle size were used. After complete lymphadenectomy, all resected lymph nodes were examined with hematoxylin-eosin staining. All sentinel nodes negative for metastases by routine staining were searched further for metastatic deposits with both serial sections and immunohistochemistry for cytokeratins.

RESULTS: The radio-guided method had a high identification rate, a high sensitivity, and a high negative predictive value (100%, 87%, and 93%, respectively) when immunohistochemistry was considered. When standard hematoxylin and eosin staining was applied, sensitivity and negative predictive value of sentinel lymph node labeling was lower (74% and 89%, respectively). No significant differences were found in either the sensitivity or negative predictive value among the colloid solutions of different particle size used in radio labeling, although smaller particles have shown a tendency to produce better results.

CONCLUSIONS: The radio-guided technique provides efficient sentinel lymph node identification in lung cancer. Further studies are warranted to confirm the clinical utility of this strategy.


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