V-081NEAR-INFRARED IMAGE-GUIDED SENTINEL LYMPH NODE IDENTIFICATION IN LUNG CANCER

Objectives: To evaluate an intraoperative, minimally invasive near-infrared (NIR) image-guided approach to sentinel lymph node (SLN) identification in lung cancer patients for initial safety and feasibility. Despite “curative” resection, recurrence rates are nearly 40% in early stage non-small-cell lung cancer (NSCLC) and five-year survival is less than 60%, outcomes largely attributable to missed nodal disease. The primary aim of SLN mapping in lung cancer is to identify the nodes at greatest risk for metastases (i.e. SLNs) for focused immunohistochemical and molecular analysis to improve staging and outcomes in this disease. Video description: In this pilot trial of 41 patients with suspected stage I/II NSCLC, peritumoural injection of NIR dye indocyanine green (ICG) was performed at the time of surgery and SLNs were detected using an NIR-specific endoscope. The SLN identification rate increased in an ICG dose-dependent fashion with 100% SLN identification at 2.5 mg ICG diluted in 1 cc of human serum albumin. A total of 28 SLNs were identified in 17 patients, with 28.5% of nodes found at the N2 station. The histopathologic status of SLNs was 100% predictive of the greater lymphadenectomy specimen. There were no adverse events. This video demonstrates the key aspects of this reproducible NIR-guided SLN biopsy technique as well as in vivo ICG lymphatic migration and nodal uptake. Conclusions: NIR image-guided SLN identification is safe and feasible in lung cancer, permitting minimally invasive, intraoperative visualization of SLNs without distortion of intrathoracic structures. The rate of SLN identification is 100% at an optimal ICG dose of 2.5 mg. SLN biopsy in lung cancer has the potential to improve staging, identify micrometastatic disease with focused analysis and aid in the selection of patients who may benefit from adjuvant chemotherapy. Disclosure: Y.L. Colson: Invited Speaker to Novadaq iSPIES conference – accommodation and airfare.