Feasibility of Non-Invasive Sentinel Lymph Node Identification in Early-Stage NSCLC Through Ultrasound Guided Intra-Tumoral Injection of 99mTc-Nanocolloid and Iodinated Contrast Agent During Navigation Bronchoscopy

Background: As the first sentinel lymph nodes (SLN) in lung cancer are most likely to harbor metastasis, their non-invasive identification could have a significant role in future treatments. We investigated the feasibility of adding an SLN procedure to a diagnostic navigation bronchoscopy. Methods:...

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Published inCancers Vol. 16; no. 22; p. 3868
Main Authors ter Woerds, Desi K. M., Verhoeven, Roel L. J., Aarntzen, Erik H. J. G., van der Heijden, Erik H. F. M.
Format Journal Article
LanguageEnglish
Published Basel MDPI AG 19.11.2024
MDPI
Subjects
Bronchoscopy
Cancer therapies
Catheters
Clinical medicine
Computed tomography
Contrast agents
Contrast media
Feasibility studies
Fluoroscopy
Injection
Lung cancer
Lymph nodes
Lymphatic system
Metastasis
Patients
Single photon emission computed tomography
Surgery
Tomography
Ultrasonic imaging
Ultrasound
United States > US
Netherlands
Japan
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Summary:Background: As the first sentinel lymph nodes (SLN) in lung cancer are most likely to harbor metastasis, their non-invasive identification could have a significant role in future treatments. We investigated the feasibility of adding an SLN procedure to a diagnostic navigation bronchoscopy. Methods: Thirty-one patients were included for injection of 99mTc-nanocolloid and an iodinated contrast agent intra-/peritumorally and assessment of tracer dissipation via SPECT and CBCT imaging. Injections were performed endobronchially using a multi-modal catheter (Pioneer Plus), combining radial ultrasound and an angulated retractable needle to place injections under fluoroscopy and real-time ultrasound. Results: The injection of an imaging tracer was feasible in all cases using the catheter. Ultrasound visualized 29/30 tumors, and tracer injection was performed in 100% of patients. An SLN was subsequently identified in 10 out of 31 cases (32.3%) via SPECT/CT imaging. Iodinated contrast agent injection under CBCT imaging prior to 99mTc nanocolloid injection visualized dissipation pathways and enabled needle relocation for subsequent 99mTc-nanocolloid injection. Conclusions: Performing imaging tracer injections with a multi-modal catheter provided safe and local depot placement immediately following diagnostic navigation bronchoscopy. SPECT/CT imaging using 99mTc-nanocolloid showed inconsistent results for SLN identification.
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ISSN:2072-6694
2072-6694
DOI:10.3390/cancers16223868