Christopher S Digesu1, Krista J Hachey2, Denis M Gilmore3, Onkar V Khullar4, Hisashi Tsukada1, Brian Whang1, Lucian R Chirieac5, Robert F Padera5, Michael T Jaklitsch1, Yolonda L Colson6. 1. Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass. 2. Department of Surgery, Boston Medical Center, Boston, Mass. 3. Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn. 4. Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga. 5. Department of Pathology, Brigham and Women's Hospital, Boston, Mass. 6. Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass. Electronic address: ycolson@partners.org.
Abstract
OBJECTIVE: To report the first analysis of long-term outcomes using near-infrared (NIR) image-guided sentinel lymph node (SLN) mapping in non-small cell lung cancer (NSCLC). METHODS: Retrospective analysis of patients with NSCLC enrolled in 2 prospective phase 1 NIR-guided SLN mapping trials, including an indocyanine green (ICG) dose-escalation trial, was performed. All patients underwent NIR imaging for SLN identification followed by multistation mediastinal lymph node sampling (MLNS) and pathologic assessment. Disease-free (DFS) and overall survival (OS) were compared between patients with NIR+ SLN (SLN group) and those without (non-SLN group). RESULTS: SLN detection, recurrence, DFS, and OS were assessed in 42 patients with NSCLC who underwent intraoperative peritumoral ICG injection, NIR imaging, and MLNS. NIR+ SLNs were identified in 23 patients (SLN group), whereas SLNs were not identified in 19 patients enrolled before ICG dose and camera optimization (non-SLN group). Median follow-up was 44.5 months. Pathology from NIR+ SLNs was concordant with overall nodal status in all 23 patients. Sixteen patients with SLN were deemed pN0 and no recurrences were, whereas 4 of 15 pN0 non-SLN patients developed nodal or distant recurrent disease. Comparing SLN versus non-SLN pN0 patients, the probability of 5-year OS is 100% versus 70.0% (P = .062) and 5-year DFS is statistically significantly improved at 100% versus 66.1% (P = .036), respectively. Among the 11 pN+ patients, 7 were in the SLN group, with >40% showing metastases in the SLN alone. CONCLUSIONS: Patients with pN0 SLNs showed favorable disease-free and overall survival. This preliminary review of NIR SLN mapping in NSCLC suggests that pN0 SLNs may better represent true N0 status. A larger clinical trial is planned to validate these findings.
OBJECTIVE: To report the first analysis of long-term outcomes using near-infrared (NIR) image-guided sentinel lymph node (SLN) mapping in non-small cell lung cancer (NSCLC). METHODS: Retrospective analysis of patients with NSCLC enrolled in 2 prospective phase 1 NIR-guided SLN mapping trials, including an indocyanine green (ICG) dose-escalation trial, was performed. All patients underwent NIR imaging for SLN identification followed by multistation mediastinal lymph node sampling (MLNS) and pathologic assessment. Disease-free (DFS) and overall survival (OS) were compared between patients with NIR+ SLN (SLN group) and those without (non-SLN group). RESULTS: SLN detection, recurrence, DFS, and OS were assessed in 42 patients with NSCLC who underwent intraoperative peritumoral ICG injection, NIR imaging, and MLNS. NIR+ SLNs were identified in 23 patients (SLN group), whereas SLNs were not identified in 19 patients enrolled before ICG dose and camera optimization (non-SLN group). Median follow-up was 44.5 months. Pathology from NIR+ SLNs was concordant with overall nodal status in all 23 patients. Sixteen patients with SLN were deemed pN0 and no recurrences were, whereas 4 of 15 pN0 non-SLN patients developed nodal or distant recurrent disease. Comparing SLN versus non-SLN pN0 patients, the probability of 5-year OS is 100% versus 70.0% (P = .062) and 5-year DFS is statistically significantly improved at 100% versus 66.1% (P = .036), respectively. Among the 11 pN+ patients, 7 were in the SLN group, with >40% showing metastases in the SLN alone. CONCLUSIONS:Patients with pN0 SLNs showed favorable disease-free and overall survival. This preliminary review of NIR SLN mapping in NSCLC suggests that pN0 SLNs may better represent true N0 status. A larger clinical trial is planned to validate these findings.
Authors: Alex G Little; Valerie W Rusch; James A Bonner; Laurie E Gaspar; Mark R Green; W Richard Webb; Andrew K Stewart Journal: Ann Thorac Surg Date: 2005-12 Impact factor: 4.330
Authors: Denis M Gilmore; Onkar V Khullar; Michael T Jaklitsch; Lucian R Chirieac; John V Frangioni; Yolonda L Colson Journal: J Thorac Cardiovasc Surg Date: 2013-06-19 Impact factor: 5.209
Authors: Gail E Darling; Mark S Allen; Paul A Decker; Karla Ballman; Richard A Malthaner; Richard I Inculet; David R Jones; Robert J McKenna; Rodney J Landreneau; Valerie W Rusch; Joe B Putnam Journal: J Thorac Cardiovasc Surg Date: 2011-03 Impact factor: 5.209
Authors: Nathan M Mollberg; Carrie Bennette; Eric Howell; Leah Backhus; Beth Devine; Mark K Ferguson Journal: Ann Thorac Surg Date: 2014-01-11 Impact factor: 4.330
Authors: Daniel J Boffa; Mark S Allen; Joshua D Grab; Henning A Gaissert; David H Harpole; Cameron D Wright Journal: J Thorac Cardiovasc Surg Date: 2007-12-21 Impact factor: 5.209
Authors: David A Mahvi; Rong Liu; Mark W Grinstaff; Yolonda L Colson; Chandrajit P Raut Journal: CA Cancer J Clin Date: 2018-10-17 Impact factor: 508.702