Sentinel lymph node biopsy for lung cancer
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REVIEW ARTICLE
Sentinel lymph node biopsy for lung cancer Alexander Gregor1 · Hideki Ujiie1,2 · Kazuhiro Yasufuku1 Received: 4 January 2020 / Accepted: 2 July 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Sentinel lymph node biopsy is a technique to identify the first lymph node (or nodes) draining a tumor. The underlying principle is that as the first site of cancer spread, evaluation of the sentinel node will be most predictive for wider nodal involvement. The introduction of sentinel node biopsy revolutionized the surgical management of cutaneous melanoma and breast cancer, becoming a key component in the management of such patients. For over 20 years, thoracic surgeons have similarly worked to apply this technique to lung cancer but have thus far not had the same impact on lung surgery. In this review, we will summarize the ongoing discussions on the role of sentinel node biopsy in lung cancer, the methods for identifying the sentinel node, and the techniques for evaluating the sentinel node specimen. We will also highlight some of the pressing questions investigators should consider when designing a trial for sentinel node mapping. This will clarify the current status of sentinel node biopsy in lung cancer and thus highlight important future directions for research. Keywords Sentinel lymph node (SLN) · Non-small cell lung cancer (NSCLC) · Indocyanine green (ICG) · Near-infrared (NIR)
Introduction In the absence of metastases, nodal status has the most significant impact on patient prognosis in non-small cell lung cancer (NSCLC) [1]. Sentinel lymph node (SLN) mapping was first described in 1992 for management of cutaneous melanoma [2]. The principle remains the same: ‘mapping agents’ are injected near a tumor and tracked until reaching the first draining node(s). These are the SLNs, and as the theoretical first site of cancer spread they are the highest yield to evaluate for nodal disease. Thoracic surgeons began studying lung SLN mapping shortly after it was described. What has followed is two decades of predominantly single-centre trials evaluating different techniques in different patients. This should not discount from a common theme: at experienced centres, SLN mapping is feasible. This enables
* Hideki Ujiie [email protected] 1
Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, West‑7, North‑15, Kita‑ku, Sapporo, Hokkaido 060‑8638, Japan
2
two discussions: first, how does SLN mapping fit into current treatment paradigms, and second, what can be learned from previous SLN mapping trials. This review will explore the role of SLN mapping in the management of NSCLC, available modalities, and key considerations for any future trials. Over the course of this review, we reference several clinical series on lung SLN mapping; we direct readers to Table 1, which summarizes many of these studies and othe
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