Ann Thorac Surg 2006;81:330
© 2006 The Society of Thoracic Surgeons
New technology
Invited commentary
Frank C. Detterbeck, MD
Division of Thoracic Surgery, Yale University, FMB 128, 330 Cedar St, New Haven, CT 06520-8062
(Email: frank.detterbeck{at}yale.edu).
Minamiya and colleagues [1], the group from Akita University, should be commended for their efforts to develop a novel technique for detection of sentinel lymph nodes in patients with lung cancer. This seems to be a promising method that may well offer advantages greater than other methods of sentinel node detection, such as blue dye or scintigraphy. As with any new technique, further refinement and assessment of the technique is necessary. However the results presented here are intriguing and exciting.
This study also underscores some of the difficulties with sentinel node mapping in lung cancer. There remains a waiting period of 20 to 30 minutes after injection before the best time to detect the sentinel node is reached. Because dissection is likely to disrupt the distribution of lymphatic flow, this generally represents wasted time.
In addition, it is not clear how sentinel node mapping in lung cancer alters the management of the patient or results in any decreased morbidity. The standard of care is either mediastinal lymph node dissection or at least a systematic sampling in each accessible nodal station at the time of thoracotomy. Data to date demonstrates no significant morbidity to either approach. Furthermore, adjuvant chemotherapy is indicated for most patients, regardless of node positivity. Therefore the advantage of sentinel node identification lies in a more accurate determination of the stage by having the pathologist focus more closely on this node, but not in a change of therapy.
A technique that could identify the sentinel node prior to thoracotomy would be potentially useful. It is possible the technique described here could be modified to allow node detection through a mediastinoscope, perhaps coupled with transbronchial injection in the periphery of the tumor. This possible application is hampered by the fact that the sentinel node is frequently an N1 node and not a mediastinal node, as particularly emphasized by this study. However the use of videomediastinoscopy may allow dissection and sampling of hilar N1 nodes.
It will be interesting to follow the evolution of this technique involving magnetic force. It may be that this approach allows identification of the sentinel node to be done in novel ways that change the applicability of sentinel node sampling altogether.
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References
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- Minamiya Y, Ito M, Katayose Y, et al. Intraoperative sentinel lymph node mapping using a new sterilizable magnetometer in patients with nonsmall cell lung cancer Ann Thorac Surg 2006;81:327-330.[Abstract/Free Full Text]
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