Radioguided Detection of Lymph Node Metastasis in Non-Small Cell Lung Cancer - Long Term Results
Martin Masika, Wei Tan, Mark Hennon, Elisabeth Dexter, Todd Demmy, Anthony Picone, Sai Yendamuri, Chukwumere Nwogu.
Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Objective: Given the clinical importance of nodal staging in locoregional non-small cell lung cancer (NSCLC) patients, we studied detection of nodal micrometastases using Fluorodeoxyglucose (FDG) uptake. We compared detection rates of an intra-operative hand-held gamma-probe to standard positron emission tomography-computed tomography (PET-CT) using immunohistochemistry (IHC) and quantitative Real-time Polymerase Chain Reaction (RT-PCR). Methods: 100 patients with suspected or confirmed stage I/II NSCLC, staged by standard PET-CT, were enrolled. Each received FDG preoperatively and underwent mediastinoscopy, anatomic lung resection and complete lymphadenectomy. The gamma probe was used to detect FDG-avid lymph nodes. RT-PCR and IHC was used to detect lymph nodes micrometastasis and all patients were followed for five years. Results: Two patients were excluded from the study after mediastinosopy revealed malignant paratracheal nodes. The sensitivity and specificity of PET-CT for detection of lymph node metastases proven by H&E/IHC were 30% and 99%, respectively. Sensitivity and specificity of the gamma-probe for detection of lymph node metastases proven by H&E/IHC were 74% and 52%, respectively. IHC and RT-PCR detected micro metastatic lymph node disease in 4 and 20 patients, respectively. In a Cox multivariable analysis, age, gender, and IHC (neg vs. pos) were significant determinants of overall survival. There was a significant difference in OS (p=0.016) in patients with IHC positive versus negative lymph nodes (Figure 1). Conclusions: In NSCLC patients, the intra-operative hand-held gamma-probe did not improve metastatic lymph node detection accuracy over standard PET-CT. Micrometastasis detected by IHC had a significant impact on patient survival, but RT-PCR had no survival-impact.
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