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Letters to the Editor

Sentinel node sampling in stage I non-small cell lung cancer

Faculty of Medicine, Mansoura University, Mansoura, Egypt

Received 2 August 2007; accepted 22 August 2007.

^_* Corresponding author. Address: 71 Elsedek Street, Ahmed Maher Street, Mansoura 35511, Egypt. Tel.: +20 502266741; fax: +20 50 2265471. (Email: mfismail2299{at}yahoo.com).

Key Words: Sentinel node • PET • Subcarinal lymph nodes

I read with interest the article titled ‘Sentinel node sampling limits lymphadenectomy in stage I non-small cell lung cancer ’ [1]. I want to thank the authors for their great efforts in introducing such good work but I have some comments.

Positron emission tomography (PET) has recently become an important noninvasive tool in mediastinal staging for NSCLC, with reported sensitivity of 61–88% and specificity of 77–96% [2]. I want to ask the authors why they did not use preoperative PET or mediastinoscopy for help in identifying the possible locations for malignant lymph nodes.

In the first study [1] there are cases with N2 showed negative NSN especially in the right upper lobe and left lower lobe that should have been better taken into consideration in the second study.

A variable number of patients who undergo resection of lung tumors with mediastinal lymph nodes have no metastatic involvement of either the hilar or lobar nodes. Such metastatic mediastinal disease is referred to as skip metastases.

Watanabe et al. [3] reported a higher frequency of metastatic involvement of lower, inferior, mediastinal lymph nodes in patients with right upper lobe lesions. They found that subcarinal lymph nodes were the only affected lymph nodes in 11% of those patients with right upper lobe primary lesions.

The lung cancer study group by Thomas et al. reported that the subcarinal lymph nodes should be evaluated in all patients regardless of the primary site of the tumor [4].

The size, site and pathology of the primary tumor and their relation to mediastinal nodal affection was not mentioned in this study despite its high importance for anticipating nodal affection. Asamura et al. [5] found that the prevalence of mediastinal metastases increases with tumor size. Also, they have found that among patients with resected peripheral NSCLC, the prevalence of lymph node metastases increased from 19.5% in tumors 2.0 cm or smaller to 32.5% in tumors 2–3.0 cm in diameter [5].

References

1. Muraoka M, Akamine S, Oka T, Tagawa T, Nakamura A, Tsuchiya A, Hayashi T, Nagayasu T. Sentinel node sampling limits lymphadenectomy in stage I non-small cell lung cancer. Eur J Cardiothorac Surg 2007;32:356-361.[Abstract/Free Full Text]
2. Reed C, Harpole D, Posther K, Woolson S, Downey R, Meyers B, Heelan R, MacApinlac H, Jung S, Silvestri G, Siegel B, Rusch V. Results of the American College of Surgeons Oncology Group Z0050 Trial: the utility of positron emission tomography in staging potentially operable non-small cell lung cancer. J Thorac Cardiovasc Surg 2003;126:1943-1951.[Abstract/Free Full Text]
3. Watanabe Y, Shimizu J, Tsubota M, Iwa T. Mediastinal spread of metastatic lymph nodes in bronchogenic carcinoma. Mediastinal nodal metastases in lung cancer. Chest 1990;97:1059-1065.[CrossRef][Medline]
4. Thomas PA, Piantadosi S, Mountain CF. Should subcarinal lymph nodes be routinely examined in patients with non-small lung cancer. J Thorac Cardiovasc Surg 1988;95:883-887.[Abstract]
5. Asamura H, Nakayama H, Kondo H, Tsuchiya R, Shimosato Y, Naruke T. Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small cell lung carcinomas. Are these carcinomas candidates for video-assisted lobectomy?. J Thorac Cardiovasc Surg 1996;111:1125-1134.[Abstract/Free Full Text]

This article has been cited by other articles:

				M. Muraoka Reply to Ismail Eur. J. Cardiothorac. Surg., December 1, 2007; 32(6): 949 - 950. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mohamed Fouad Ismail Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ismail, M. F. Search for Related Content PubMed PubMed Citation Articles by Ismail, M. F. Related Collections Lung - cancer Lung - basic science