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. 2018 Mar;155(3):1280-1291.
doi: 10.1016/j.jtcvs.2017.09.150. Epub 2017 Dec 14.

Long-term outcomes after near-infrared sentinel lymph node mapping in non-small cell lung cancer

Christopher S Digesu  1 , Krista J Hachey  2 , Denis M Gilmore  3 , Onkar V Khullar  4 , Hisashi Tsukada  1 , Brian Whang  1 , Lucian R Chirieac  5 , Robert F Padera  5 , Michael T Jaklitsch  1 , Yolonda L Colson  6
Affiliations

Long-term outcomes after near-infrared sentinel lymph node mapping in non-small cell lung cancer

Christopher S Digesu et al. J Thorac Cardiovasc Surg. 2018 Mar.

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.

Keywords: lung cancer; near-infrared; outcomes; sentinel lymph node.

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Conflict of interest statement

Conflict of Interest Statement: Authors have nothing to disclose with regard to commercial support.

Figures

Figure 1
Figure 1
Study design and characteristics of sentinel lymph node (SLN) and non–sentinel lymph node groups. NIR, Near-infrared; MLNS, mediastinal lymph node sampling.
Figure 2
Figure 2
Level 7 lymph node following near-infrared sentinel lymph node mapping. The blue arrow indicates the sentinel lymph node that was the only lymph node positive for metastatic disease within this nodal station. The white arrow indicates another lymph node in the same station that was near-infrared-negative and did not show evidence of metastatic disease.
Figure 3
Figure 3
A, Overall survival (P = .062). B, Disease-free survival (P = .036). Shaded area represents the 95% confidence interval. SLN, Sentinel lymph node; pN0, pathologic node negative.
See this image and copyright information in PMC

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