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Eur J Cardiothorac Surg 2003;23:824-827
© 2003 Elsevier Science NL

Bronchoscopic radioisotope injection for sentinel lymph-node mapping in potentially resectable non-small-cell lung cancer

^a Division of Thoracic Surgery, University Hospital, Zurich, Switzerland
^b Division of Pneumology, University Hospital, Zurich, Switzerland
^c Department of Pathology, University Hospital, Zurich, Switzerland
^d Department of Anaesthesiology, University Hospital, Zurich, Switzerland
^e Division of Nuclear Medicine, University Hospital, Zurich, Switzerland

Received 24 October 2002; received in revised form 19 December 2002; accepted 27 January 2003.

^* Corresponding author. Tel.: +41-1-255-8802; fax: +41-1-255-8805
e-mail: didier.lardinois{at}chi.usz.ch

Objective: Prospective study to evaluate the feasibility of a preoperative bronchoscopic radioisotope application, followed by conventional sentinel lymph-node (SLN) identification and to investigate the occurrence and distribution of micrometastases in relation to SLN activity. Methods: Twenty patients with a mean age of 63 years and proven clinical stage T1-3 N0-1 non-small-cell lung cancer (NSCLC) were included. A dosage of 80 MBq radiolabeled technetium-99m nanocolloid was endoscopically administrated on intubated patients in the operation theatre. At thoracotomy, scintigraphic readings of both the primary tumor and hilar and mediastinal lymph-node stations were obtained with a hand-held gamma-counter. Patients underwent lung resection and mediastinal lymphadenectomy. Radiolabeled nodes were also examined separately on back-table. SLNs were defined as the hottest nodes or nodes with at least one-tenth of the radioactivity of the hottest nodes. SLNs pathologic assessment included standard examination using hematoxylin and eosin staining on step sections and immunohistochemistry (ICH) for cytokeratins. Results: Identification of SLNs was possible in 19/20 (95%) patients after bronchoscopic radioisotope application. In 7/19 (37%) patients, a unique SLN was identified, whereas in 12/19 (63%) patients, nodes from two different stations could be classified as SLNs. Metastatic nodal disease was found in 9/19 (47%) patients. ICH revealed micrometastases in 2/12 (17%) patients, initially classified nodal negative. Pathologic negative SLNs were a predictor for absence of metastatic nodal disease after mediastinal lymphadenectomy. No complication related to the procedure was observed. Conclusion: Our preliminary results suggest that preoperative bronchoscopic radioisotope injection for SLN identification is a safe and simple method, improving accuracy of SLN detection in comparison to intraoperative technique. The absence of metastases in the SLNs seems to predict a negative nodal status accurately.

Key Words: Non-small-cell lung cancer • Sentinel lymph-node identification • Bronchoscopic technique • Radionucleide • Micrometastases

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