Abstract
Purpose
We aimed to evaluate the results of sentinel lymph node mapping according to injection time (preoperative vs. intraoperative) of technetium-99m neomannosyl human serum albumin (99mTc-MSA) in patients with lung cancer.
Methods
Data of 82 patients (55 men; mean age 62.9 ± 9.3 years) who were candidates for lobectomy with mediastinal lymph node dissection for clinical stage I non–small cell lung cancer were retrospectively reviewed. 99mTc-MSA was administered at the peritumoral region under chest computed tomographic guidance, 1 to 2 h before surgery (preoperation group, n = 48) or soon after thoracotomy (intraoperation group, n = 34).
Results
Patients’ demographic data, except type of operation, did not differ between the two groups. Sentinel lymph nodes were detected in 46 patients (95.8%) in the preoperation group and 33 patients (97.1%) in the intraoperation group (P = .243). The mean number of sentinel nodes per patient was 2.1 in the preoperation group and 2.6 in the intraoperation group (P = .068). No falsely negative sentinel nodes were detected in any of the 17 patients with N1 or N2 disease (0%) in either group. Administration of the intraoperative injection could save additional cost (US$607) and time (70 min) in each patient.
Conclusions
Sentinel node identification using 99mTc-MSA appears to provide similar excellent results in both preoperative and intraoperative injection. Therefore, intraoperative injection of 99mTc-MSA may be preferred as a result of lower cost and less waste of time.
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References
Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg. 2011;141:662–70.
Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006;81:1013–9.
Atinkaya C, Ozlem Kucuk N, Koparal H, Aras G, Sak SD, Ozdemir N. Mediastinal intraoperative radioisotope sentinel lymph node mapping in non-small-cell lung cancer. Nucl Med Commun. 2005;26:717–20.
Little AG, DeHoyos A, Kirgan DM, Arcomano TR, Murray KD. Intraoperative lymphatic mapping for non-small cell lung cancer: the sentinel node technique. J Thorac Cardiovasc Surg. 1999;117:220–4.
Liptay MJ, Masters GA, Winchester DJ, et al. Intraoperative radioisotope sentinel lymph node mapping in non-small cell lung cancer. Ann Thorac Surg. 2000;70:384–9.
Nomori H, Iwatani K, Kobayashi H, Mori A, Yoshioka S. Omission of mediastinal lymph node dissection in lung cancer: its techniques and diagnostic procedures. Ann Thorac Cardiovasc Surg. 2006;12:83–8.
Nomori H, Ikeda K, Mori T, et al. Sentinel node navigation segmentectomy for clinical stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg. 2007;133:780–5.
Jeong JM, Hong MK, Kim YJ, et al. Development of 99mTc-neomannosyl human serum albumin (99mTc-MSA) as a novel receptor binding agent for sentinel lymph node imaging. Nucl Med Commun. 2004;25:1211–7.
Kim S, Kim HK, Kang DY, Jeong JM, Choi YH. Intra-operative sentinel lymph node identification using a novel receptor-binding agent (technetium-99m neomannosyl human serum albumin, 99mTc-MSA) in stage I non-small cell lung cancer. Eur J Cardiothorac Surg. 2010;37:1450–6.
Liptay MJ, D’Amico TA, Nwogu C, et al. Intraoperative sentinel node mapping with technitium-99 in lung cancer: results of CALGB 140203 multicenter phase II trial. J Thorac Oncol. 2009;4:198–202.
Nomori H, Horio H, Naruke T, Orikasa H, Yamazaki K, Suemasu K. Use of technetium-99m tin colloid for sentinel lymph node identification in non-small cell lung cancer. J Thorac Cardiovasc Surg. 2002;124:486–92.
Henze E, Schelbert HR, Collins JD, Najafi A, Barrio JR, Bennett LR. Lymphoscintigraphy with Tc-99m-labeled dextran. J Nucl Med. 1982;23:923–9.
Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K. In vivo identification of sentinel lymph nodes for clinical stage I non-small cell lung cancer for abbreviation of mediastinal lymph node dissection. Lung Cancer. 2004;46:49–55.
He XM, Carter DC. Atomic structure and chemistry of human serum albumin. Nature. 1992;358:209–15.
Minamiya Y, Ito M, Katayose Y, et al. Intraoperative sentinel lymph node mapping using a new sterilizable magnetometer in patients with nonsmall cell lung cancer. Ann Thorac Surg. 2006;81:327–30.
Riquet M, Hidden G, Debesse B. Direct lymphatic drainage of lung segments to the mediastinal nodes. An anatomic study on 260 adults. J Thorac Cardiovasc Surg. 1989;97:623–32.
Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H. Prognosis of completely resected pN2 non-small cell lung carcinomas: what is the significant node that affects survival? J Thorac Cardiovasc Surg. 1999;118:270–5.
Naruke T, Tsuchiya R, Kondo H, Nakayama H, Asamura H. Lymph node sampling in lung cancer: how should it be done? Eur J Cardiothorac Surg. 1999;16(Suppl 1):S17–24.
Asamura H, Nakayama H, Kondo H, Tsuchiya R, Naruke T. Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis. J Thorac Cardiovasc Surg. 1999;117:1102–11.
Melfi FM, Chella A, Menconi GF, et al. Intraoperative radioguided sentinel lymph node biopsy in non–small cell lung cancer. Eur J Cardiothorac Surg. 2003;23:214–20.
Liptay MJ, Grondin SC, Fry WA, et al. Intraoperative sentinel lymph node mapping in non-small-cell lung cancer improves detection of micrometastases. J Clin Oncol. 2002;20:1984–8.
Sugi K, Kaneda Y, Sudoh M, Sakano H, Hamano K. Effect of radioisotope sentinel node mapping in patients with cT1 N0 M0 lung cancer. J Thorac Cardiovasc Surg. 2003;126:568–73.
Lardinois D, Brack T, Gaspert A, et al. Bronchoscopic radioisotope injection for sentinel lymph-node mapping in potentially resectable non-small-cell lung cancer. Eur J Cardiothorac Surg. 2003;23:824–7.
Rzyman W, Hagen OM, Dziadziuszko R, et al. Intraoperative, radio-guided sentinel lymph node mapping in 110 nonsmall cell lung cancer patients. Ann Thorac Surg. 2006;82:237–42.
Nomori H, Ohba Y, Yoshimoto K, et al. Difference of sentinel lymph node identification between tin colloid and phytate in patients with non-small cell lung cancer. Ann Thorac Surg. 2009;87:906–10.
Acknowledgment
Supported by a grant of the Korean Health Technology R&D Project, Ministry of Health, Welfare and Family Affairs, Republic of Korea (A070001).
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Kim, H.K., Kim, S., Sung, H.K. et al. Comparison between Preoperative Versus Intraoperative Injection of Technetium-99 m Neomannosyl Human Serum Albumin for Sentinel Lymph Node Identification in Early Stage Lung Cancer. Ann Surg Oncol 19, 1343–1349 (2012). https://doi.org/10.1245/s10434-011-2130-4
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DOI: https://doi.org/10.1245/s10434-011-2130-4