Elsevier

The Annals of Thoracic Surgery

Volume 82, Issue 5, November 2006, Pages 1815-1820
The Annals of Thoracic Surgery

Original article
General thoracic
Radioguided Detection of Lymph Node Metastasis in Non-Small Cell Lung Cancer

Presented at the Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.
https://doi.org/10.1016/j.athoracsur.2006.05.104Get rights and content

Background

The detection of micrometastases in thoracic lymph nodes may improve the staging of non-small cell lung cancer patients.

Methods

Ten patients with resectable lung cancers were enrolled in this pilot study. Every patient had preoperative positron emission tomography (PET) imaging and mediastinoscopy. Patients were injected with 10 mCi of F18-fluorodeoxyglucose (FDG) on the day of surgery, within 4 hours of the planned surgical procedure. A handheld device detected increased FDG uptake (gamma emission) within thoracic lymph nodes during pulmonary resection procedures. The lymph nodes that demonstrated increased FDG uptake, but were nonmalignant by conventional hematoxylin and eosin staining, underwent further serial sectioning and immunohistochemical staining.

Results

The handheld probe detected all FDG-avid lesions on PET imaging. In 3 patients (30%), the probe led to the detection of FDG-avid lymph nodes harboring micrometastases missed by conventional pathologic analysis. A fourth patient had aortopulmonary nodes that were FDG-avid on PET and showed metastases by hematoxylin and eosin staining, but the probe detected adjacent nodes in the same station with micrometastases. Three nodes were false-positive by gamma probe.

Conclusions

It is feasible to detect occult metastases in lymph nodes by using an FDG-sensitive intraoperative gamma probe, resulting in upstaging of patients. A larger study is indicated to evaluate the sensitivity, specificity, and clinical utility of such a device.

Section snippets

Patients and Methods

Our Institutional Review Board approved this pilot study in January 2004, and individual patient consent was obtained.

Results

We screened 12 patients (7 men) for the protocol. Two were ineligible owing to the diagnosis of a pulmonary granuloma in 1 patient and bulky mediastinal nodal disease in the other. The characteristics of the 10 eligible patients are summarized in Table 1. All of the patients had FDG-avid primary lung tumors on the preoperative PET scan, but 3 of 10 patients were staged as lymph node–negative by this preoperative scan (Table 2).

Mediastinoscopy revealed malignant ipsilateral lower paratracheal

Comment

It is estimated that there will be 174,470 new cases and 162,460 deaths from lung cancer in the United States in 2006 [1]. This accounts for more deaths than the estimates for prostate, breast, and colon cancer combined. Thus, the human and economic impact of lung cancer is enormous.

The staging of lung cancer plays a critical role in efforts to combat this disease, but progress in the ability to accurately identify all lymph node disease in patients has been limited. This is reflected in the

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