Sentinel node navigation segmentectomy for clinical stage IA non-small cell lung cancer

Objective: Intraoperative frozen section examination of sentinel lymph nodes was conducted to determine the final indication for segmentectomy for clinical T1 N0 M0 non-small cell lung cancer. Methods: Between April 2005 and July 2006, 52 patients with clinical T1 N0 M0 non-small cell lung cancer were prospectively treated by segmentectomy with sentinel node identification. The day before surgery, technetium-99m tin colloid was injected into the peritumoral region. After segmentectomy and lymph node dissection, sentinel nodes identified by measuring radioactive tracer uptake were examined for intraoperative frozen sections, which were serially cut 2 to 3 mm in thickness. When sentinel node metastasis was observed, segmentectomy was converted to lobectomy. Results: Sentinel nodes were identified in 43 ( 83%) patients. The average number of sentinel nodes was 1.6 +/- 0.9 ( range: 1-5) per patient. Of 3 patients with metastatic sentinel lymph nodes, 2 underwent lobectomy and 1 larger segmentectomy. None of the other 40 patients had metastatic sentinel lymph nodes and therefore they were treated with segmentectomy. Pathologic staging with permanent sections was N0 in all of the 40 patients. On the other hand, in 9 patients whose sentinel nodes could not be identified, intraoperative frozen sections were required for 5.4 +/- 2.3 lymph nodes, which was significantly more than 1.6 +/- 0.9 in the 43 patients with sentinel node identification ( P < .001). Conclusion: Sentinel node identification is useful to determine the final indication of segmentectomy for clinical T1 N0 M0 non-small cell lung cancer by targeting the lymph nodes needed for intraoperative frozen section diagnosis.