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Supplement: The Minimally Invasive Thoracic Surgery Summit

Sentinel Node Mapping in Lung Cancer: The Holy Grail?

Division of Thoracic Surgery, Rush University Medical Center, Chicago, Illinois

^_* Address correspondence to Dr Liptay, Rush University Medical Center, Division of Thoracic Surgery, 1725 W. Harrison, Ste 774, Chicago, IL 60612-3824 (Email: michael_liptay@rush.edu).

Presented at the Minimally Invasive Thoracic Surgery Summit, New York, NY, June 8–9, 2007.

The first 20% of the full text of this article appears below.

	Introduction

 
Sentinel node identification has become standard of surgical care for melanoma and breast cancer. The idea of a first nodal station draining a tumor theoretically would allow the assessment of that node(s) to represent the state of the remaining regional nodes. The sentinel node is used to limit potentially morbid lymph node dissections. Another benefit of the technique is directing applications of more focused pathologic or molecular staging techniques such as serial sections, immunohistochemistry, and reverse transcription-polymerase chain reaction. This ability to direct a more focused search for metastatic disease in the sentinel node rather than all of the nodes removed is a primary benefit of the technique in lung cancer.

Most reported clinical trials and experience with the sentinel node technique in lung cancer were conceived before the current data supporting adjuvant chemotherapy for all node-positive patients. With current indications for adjuvant chemotherapy in resected lung cancer largely determined by the status of the locoregional lymph nodes, the accurate identification of positive nodes has gained therapeutic importance. Sentinel node identification may aid identification of more patients who could benefit from postoperative chemotherapy. Patients with only micrometastatic nodal disease in theory should benefit as well, but the data are less clear.

	Intraoperative Tracer Injection

 
The application of the sentinel node technique to lung cancer began with Little and colleagues [1] in 1999. The use of isosulfan blue dye resulted in an identification rate of slightly less than 50%. The primary drawback of the blue dye was the frequent black anthracosis encountered in . . . [Full Text of this Article]

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