Intraoperative Detection Of Sentinel Lymph Nodes Using Indocyanine Green Fluorescence Imaging System In Non-small Cell Lung Cancer

BackgroundThe incidence rate of lung cancer patients around the world has shown a rapid upward trend, lung cancer has become the first major malignant tumors, the incidence and mortality of all cancers, including NSCLC (non-small cell lung cancer, NSCLC) accounts for about80%-85%of all lung cancer cases, for early stage non-small cell lung cancer, surgery operation treatment is still the main means of treatment, and is the basis of a small number of patients may cure for lung cancer. Relatively complete standard system of lymph node dissection has become and scholar NCCN guidelines and many medical institutions consensus, but the standard systematic lymphadenectomy in operation time, operation wound, and the ensuing postoperative adverse event rate increased and the patients’ quality of life decline problems and limits its widely carried out, and not in line with the concept of damage control.Lung cancer sentinel lymph node detection and location technology and guide minimally invasive operation provides us a new way of thinking. If we can accurately locate the sentinel lymph node metastasis of lung cancer, the sentinel node, determination of lymph node dissection, cleaning to reduce unnecessary lymph nodes in patients with lung cancer, will give a great, lung cancer is a minimally invasive operation breakthrough and revolution. But due to lung cancer sentinel lymph node detection means such as defect dye method and radionuclide method, makes it difficult to use and development, in recent years, near infrared fluorescence imaging technology with its specificity and high resolution have been widely used in various fields, in lung cancer surgery technology and equipment development will make the minimally invasive operation in lung cancer the possible.ObjectiveIndocyanine green fluorescence imaging system as a surgical navigation technology obtained the affirmative effect in the clinical application of gastric cancer, breast cancer, skin cancer and other tumor surgery, and surgical treatment of indocyanine green fluorescence imaging system is used in non small cell lung cancer reported rarely, this experiment aims to study near-infrared fluorescence imaging technology and equipment for detection of non-small cell lung cancer sentinel lymph node rate, the accuracy of the judgment of lymph node metastases in operation, and according to the state of pathological tissue of sentinel lymph node in science to guide patients with non-small cell lung cancer lymph node dissection, carries on the preliminary discussion.Methods1、17cases of cla and cIIa of NSCLC patients, intraoperative cancer peripheral injection of ICG15min, luminous lymph node definition of near infrared fluorescence imaging system for SLN;2-. All patients underwent lobectomy+systematic lymphadenectomy DL, lymph node splicing, pick, group and continue along the section of lung cancer bronchial tree along the dissection of intrapulmonary lymph nodes, Twelfth group,13group,14group has access to lymph nodes, again near infrared light to confirm light, lymph nodes are defined as SLN;3、All lymph nodes examined pathologically, the staining of HE negative lymph nodes continue immunohistochemical examination.Results1、14cases of successful recognition of SLN, in17patients, the recognition rate is82.4%(14/17), were detected by33SLN, average2.4/cases, including4cases ofl SLN、4cases of2SLN、3cases of3SLN、3cases of4SLN;2、In patients of14cases recognition of SLN,2cases SLN positive, SLN positive, mediastinal lymph node also has metastasis in2patients (pTNM Ⅲa2);12cases of negative SLN with metastasis of mediastinal lymph node nonmetastasis(pTNM Ia3例,Ⅰb9例).3patients were not detected SLN, pTNM I b1cases, IIb2cases;3、stage I this set of experiments of13cases in12cases detected by SLN, the recognition rate is92.3%(12/13);4、the SLN detection sensitivity was100%(2/2), the accuracy rate was100%(12/12), false negative rate0. Conclusion1、The recognition rate of SLN was82.4%(14/17), the accuracy rate was100%(12/12), the false negative rate was0, confirmed that the application of indocyanine green fluorescence imaging system of exploring NSCLC sentinel lymph node technique on early especially SLN recognition rate and regional lymph in stage I NSCLC has higher the node metastasis prediction, is a safe, simple, effective and practical method to determine the regional lymph node status, and have high specificity and sensitivity, strong operability, is expected in the NSCLC regional lymph node status judgement, making operation scheme plays an important role.2、By indocyanine green fluorescence imaging system of tracer can find Jumping and micrometastasis of lymph node in NSCLC, helping after complete clearance of lymph node of NSCLC, ensure the NSCLC radical treatment.3、Intraoperative detection of sentinel lymph nodes using indocyanine green fluorescence imaging system exist the learning curve, the accumulation of experience is helpful to improve the recognition rate of sentinel lymph nodes.4、The study, combining with2012breast cancer NCCN guide SLN biopsy approach, we explore and puts forward the following strategies:early operation on the assumption of NSCLC patients, using indocyanine green fluorescence imaging system was not detected in SLN patients, then need systemic lymph node dissection; detected in patients with SLN, if the SLN transfer need to continue, systematic lymph node dissection, if SLN without metastasis, and meet the following3conditions:(1)、with T1or without adenocarcinoma T2;(2)、only were detected in1or2SLN;(3)、no mediastinal SLN, are not systematic lymph node dissection, only underwent SLN biopsy. If you can not meet the above conditions, should continue to do systematic lymph node dissection. Comparative study of course mentioned above need further many clinical cases.However, the application of indocyanine green fluorescence imaging system to explore NSCLC sentinel lymph node is less reported, bulk cases control study its effect remains to be further evaluation.