Shafiei Susan, Bagheri Reza, Sadeghi Ramin, Dabbagh Kakhki Vahid Reza, Jafarian Amir Hossein, Afghani Reza, Attaran Davood, Basiri Reza, Lari Shahrzad M
Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Asia Ocean J Nucl Med Biol. 2019 Spring;7(2):153-159. doi: 10.22038/AOJNMB.2019.13195.
Lymph node metastases are the most significant prognostic factor in localized non-small cell lung cancer (NSCLC). Identification of the first nodal drainage site (sentinel node) may improve detection of metastatic nodes. Extended surgeries, such as lobectomy or pneumonectomy with lymph node dissection, are among the therapeutic options of higher acceptability. Sentinel node biopsy can be an alternative approach to less invasive surgeries. The current study was conducted to evaluate the accuracy of sentinel node mapping in patients with NSCLC using an intraoperative radiotracer techniques.
This prospective study was conducted on 21 patients with biopsy-proven NSCLC who were candidates for sentinel node mapping during 2012-2014. All patients underwent thoracoabdominal computed tomography, based on which they had no lymph node involvement. Immediately after thoracotomy and before mobilizing the tumor, peritumoral injection of 2mCi/0.4 mL Tc-99m- phytate was performed in 4 corners of tumor. After mobilization of the tumoral tissues, the sentinel nodes were searched for in the hillar and mediastinal areas using hand-held gamma probe . Any lymph node with in vivo count twice the background was considered as sentinel node and removed and sent for frozen section evaluation. All dissected nodes were evaluated by step sectioning and hematoxylin and eosin staining (H&E).The recorded data included age, gender, kind of pathology, site of lesion, number of dissected sentinel nodes, number of sentinel nodes, and site of sentinel nodes. Data analysis was performed in SPSS software (version 22).
The mean age of the patients was 58.52±11.46 years with a male to female ratio of 15/6. The left lower lobe was the most commonly affected site (30.09%). Squamous cell carcinoma and adenocarcinoma were detected in 11 and 10 subjects, respectively. A total of 120 lymph nodes were harvested with the mean number of 5.71±2.9 lymph nodes per patient. At least one sentinel node was identified in each patient, resulting in a detection rate of 95.2%. The mean number of sentinel nodes per patient was 3.61±2. Frozen section results showed 100% concordance with the results of hematoxylin and eosin staining.
Based on the findings, sentinel node mapping can be considered feasible and accurate for lymph node staging and NSCLC treatment.
淋巴结转移是局限性非小细胞肺癌（NSCLC）最重要的预后因素。识别首个淋巴结引流部位（前哨淋巴结）可能会提高转移性淋巴结的检出率。扩大手术，如肺叶切除术或肺切除术加淋巴结清扫术，是可接受性较高的治疗选择。前哨淋巴结活检可以作为侵入性较小手术的替代方法。本研究旨在使用术中放射性示踪技术评估NSCLC患者前哨淋巴结定位的准确性。
本前瞻性研究对21例经活检证实为NSCLC且在2012年至2014年期间适合进行前哨淋巴结定位的患者进行。所有患者均接受了胸腹计算机断层扫描，结果显示他们没有淋巴结受累。开胸后且在移动肿瘤之前，在肿瘤的4个角分别瘤周注射2mCi/0.4 mL锝-99m-植酸盐。移动肿瘤组织后，使用手持式γ探测器在肺门和纵隔区域寻找前哨淋巴结。任何体内计数是背景两倍的淋巴结都被视为前哨淋巴结并切除，送去进行冰冻切片评估。所有切除的淋巴结均通过连续切片和苏木精-伊红染色（H&E）进行评估。记录的数据包括年龄、性别、病理类型、病变部位、切除的前哨淋巴结数量、前哨淋巴结数量以及前哨淋巴结的部位。在SPSS软件（版本22）中进行数据分析。
患者的平均年龄为58.52±11.46岁，男女比例为15/6。左下叶是最常受累的部位（30.09%）。分别在11例和10例患者中检测到鳞状细胞癌和腺癌。共采集了120个淋巴结，每位患者平均采集5.71±2.9个淋巴结。每位患者至少识别出1个前哨淋巴结，检出率为95.2%。每位患者前哨淋巴结的平均数量为3.61±2个。冰冻切片结果与苏木精-伊红染色结果100%一致。
基于这些发现，前哨淋巴结定位对于淋巴结分期和NSCLC治疗可被认为是可行且准确的。
