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. 2025 Mar 14:15:1474887.
doi: 10.3389/fonc.2025.1474887. eCollection 2025.

Sentinel lymph node detection for lung cancer surgery: a possible pathological surrogate of overall lymph node dissection

Florent Stasiak  1 , Joseph Seitlinger  1 , Lyndon C Walsh  1 , Arthur Streit  1 , Joelle Siat  1 , Guillaume Gauchotte  2   3 , Lucie Schnedecker  2 , Stéphane Renaud  1   3
Affiliations

Sentinel lymph node detection for lung cancer surgery: a possible pathological surrogate of overall lymph node dissection

Florent Stasiak et al. Front Oncol. .

Abstract

Background: Systematic lymph node dissection (SLND) is currently the gold standard for lung cancer surgery. However, this is not the case for breast cancer or melanoma, where sentinel lymph node (SLN) identification is routine. The SLN could be a possible surrogate for the pathological status of the other lymph nodes, but there is limited data in the literature for lung cancer surgery. The main objective of this study was to evaluate pathological concordance between the SLN and the complete lymphadenectomy.

Methods: In this retrospective study, we reviewed all cases of localized lung cancer that had benefited from our SLN identification protocol and underwent surgery (segmentectomy or lobectomy) between December 2020 and December 2023. We examined the pathological status of the SLN and the rest of the lymph node dissection to assess the pathological concordance rate.

Results: After exclusion, 106 patients with localized stage I-IIA non-small cell lung cancer and suspected node negative disease (N0) were included in our study. Of these 106 patients, 96 had a pN0 SLN (90.6%) and 10 had a positive SLN (pN+), resulting in an upstaging rate of 9.4%. All patients with a pN0 SLN were also pN0 for the rest of the lymph node dissection, corresponding to a pathological concordance rate of 100%. Disease-free survival was statistically lower in the pN+ SLN group than in the pN0 SLN group (p<0.0001).

Conclusion: We demonstrated a 100% pathological concordance between SLN when it is cancer-free and the rest of the lymph nodes in the lymph node dissection, suggesting that the SLN is a good indicator of the overall pathological status of the other lymph nodes in the thorax.

Keywords: indocyanin green (ICG); lung cancer; lymph node dissection; sentinel lymph node; thoracic surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Sentinel node detection protocol. (A) General flow of sentinel node protocol; (B) Sentinel node detection in station 7; (C) Sentinel node in station 3a with a visualized lymphatic pathway from the left upper lobe.
Figure 2
Figure 2
Flowchart of included patients. NSCLC, Non-Small Cell Lung Cancer; SLN, Sentinel Lymph Node; LND, Lymph node dissection.
Figure 3
Figure 3
Disease free survival of sentinel lymph node positive (pN+) vs. sentinel lymph node negative (pN0) patients.
See this image and copyright information in PMC

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