Abstract:

Objective: To find a method to accurately locate sentinel lymph nodes (SLN) in patients with stage Ⅰa non-small cell lung cancer (NSCLC) and to verify the rationality of SLN as a lymph node sample. Methods: A prospective study was conducted to include 50 patients with stage Ⅰa NSCLC in the Thoracic Surgery Department of Shandong Provincial Public Health Clinical Center from January 2021 to December 2023 according to the enrollment criteria. The tracer indocyanine green was injected around the tumor by LungPoint navigation tracheoscopy before surgery, and SLN localization was completed by fluorescence thoracoscopic imaging. The pathological examination of regional lymph nodes including SLN was performed, and the recognition rate, accuracy rate and false negative rate of SLN were used to verify the rationality of the method as a lymph node sampling sample. Results: Among the 50 patients, SLN was detected in 41 cases, with a recognition rate of 82.0% (41/50), of which 3 patients were detected with lymph node metastasis (SLN positive), a total of 9 lymph nodes, and 1 patient also detected 2 positive non-sentinel lymph nodes (N-SLN). In 9 patients, no SLN was detected, 54 lymph nodes were dissected, and no metastatic lymph nodes were found, so the accuracy rate of SLN was 100.0% (41/41) and the false negative rate was 0 (0/3). Conclusion: With the help of LungPoint tracheoscopy to inject the tracer indocyanine green around the tumor, the SLN technology explored by fluorescence thoracoscopic imaging has a high predictability of regional lymph node metastasis, which is expected to be the basis for guiding the systematic lymph node sampling of stage Ⅰa NSCLC.

Key words: Carcinoma, non-small-cell lung, Sentinel lymph node biopsy, Indocyanine green, Microscopy, fluorescence