Video-assisted thoracoscopic indocyanine green fluorescence imaging system shows sentinel lymph nodes in non-small-cell lung cancer

J Thorac Cardiovasc Surg. 2011 Jan;141(1):141-4. doi: 10.1016/j.jtcvs.2010.01.028. Epub 2010 Apr 14.

Abstract

Objective: The primary objective was to assess the feasibility and accuracy of intraoperative sentinel lymph node mapping by using a video-assisted thoracoscopic indocyanine green fluorescence imaging system in patients with clinical stage I non-small-cell lung cancer.

Methods: Thirty-one patients who underwent operation between January 2009 and September 2009 were investigated for sentinel node biopsy. Indocyanine green fluorescence imaging was applied by an infrared light charge-coupled device, and sentinel nodes were identified intraoperatively and dissected. Histologic examination by hematoxylin-eosin staining was used to evaluate metastases.

Results: Sentinel lymph nodes were identified by segmentectomy in 11 of 14 patients (78.5%) and by lobectomy in 14 of 17 patients (82.4%). The total identification rate was 80.7% (25/31 patients), the false-negative rate was 0% (0/24 patients), and the overall accuracy rate was 80.7% (25/31 patients).

Conclusion: Video-assisted thoracoscopic indocyanine green fluorescence image-guided surgery is feasible for sentinel node biopsy and may be a powerful tool to eliminate unnecessary lymph node dissection in patients with lung cancer.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / pathology*
  • Carcinoma, Non-Small-Cell Lung / surgery*
  • False Negative Reactions
  • Feasibility Studies
  • Female
  • Fluorescence
  • Fluorescent Dyes*
  • Humans
  • Indocyanine Green*
  • Japan
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / surgery*
  • Lymph Node Excision
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Pneumonectomy
  • Predictive Value of Tests
  • Sentinel Lymph Node Biopsy / methods*
  • Thoracic Surgery, Video-Assisted*

Substances

  • Fluorescent Dyes
  • Indocyanine Green