Utility and pitfalls of sentinel node identification using indocyanine green during segmentectomy for cT1N0M0 non-small cell lung cancer.

Abstract

Sentinel node identification using indocyanine green (ICG) is not only simpler, but also more cost-effective, than using radioisotope tracers. We herein examined the utility and pitfalls of sentinel node (SN) identification using ICG during segmentectomy in patients with cT1N0M0 non-small cell lung cancer (NSCLC). ICG was injected around the tumor after thoracotomy, followed by segmentectomy and lymph node dissection, in 135 patients with cT1N0M0 NSCLC. The dissected nodes were examined using an ICG fluorescence imaging system. SNs could be identified in 113 patients (84%). The mean number of SNs was 2.3±1.3. The percentages of being an SN were 57% for both stations #12 and #13, which was significantly higher than the 18% for #10 and 22% for #11 (p<0.001). Fourteen patients had N1 or N2 disease. Of these, the SNs were true positive (i.e., SNs contained metastasis) in 11 patients (79%) and false negative (i.e., SNs did not contain metastasis, while non-SNs contained metastasis) in three patients (21%). Of the three patients with false-negative results, all non-SNs containing metastases were at station #12 or #13. While ICG makes it simple to identify SNs during segmentectomy for cT1N0M0 NSCLC, stations #12 and #13 should be submitted for frozen sections along with the identified SNs to avoid missing true SNs.