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Ann Thorac Surg 2000;70:389-390
© 2000 The Society of Thoracic Surgeons

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Original articles: general thoracic

Discussion

	Discussion

 
Dr. Claude Deschamps (Rochester, MN): I would like to thank Dr Liptay for sending me his manuscript in advance and congratulate him and his group for this very innovative and excellent presentation.

Just as some of us were thinking that nothing really new was happening in lung cancer surgery, at least in the operating room, Dr Liptay and his colleagues bring us a new gadget and radioisotope and potentially more insight into the staging of non–small cell lung cancer. The true sentinel lymph node is the lymph node most likely to harbor metastatic disease if regional nodal metastasis is present. Doctor Liptay and his colleagues have demonstrated elegantly that the lymph node they identify as the sentinel node was metastatic roughly one third of the time with an accuracy of 95%. The success of sentinel node technique depends on identifying the first lymph node draining the primary tumor. The sentinel node should be the first draining node and the only hot node if the mapping procedure is performed timely after injection. In the case of breast cancer, as time goes on, the isotope material flows further up the chain of nodes and additional nodes become hot; not only that, the hottest node is not always the sentinel node.

Potential benefits of this modality include clarification of the concept of skip metastasis and the decrease in morbidity of the lymphadenectomy, although in our database in Rochester, lymphadenectomy accounts for only less than 3% of significant morbidity after thoracotomy for lung cancer. Perhaps the greatest benefit of the sentinel node technique is to allow for a more thorough pathologic examination of the sentinel node, because the false-negative rate of frozen section can be . . . [Full Text of this Article]

Related Article

Intraoperative radioisotope sentinel lymph node mapping in non–small cell lung cancer

Michael J. Liptay, Gregory A. Masters, David J. Winchester, Brian L. Edelman, Ben J. Garrido, Todd R. Hirschtritt, Reid M. Perlman, and Willard A. Fry
Ann. Thorac. Surg. 2000 70: 384-389. [Abstract] [Full Text] [PDF]