Intraoperative diagnosis of lymph node metastasis during segmentectomy for non‐small cell lung cancer by rapid immunohistochemistry using noncontact alternating current electric field mixing

Abstract

Background: Although lobectomy is considered the standard surgery for any non-small cell lung cancer (NSCLC), recent evidence indicates that for early NSCLCs segmentectomy may be equally effective. For segmentectomy to be oncologically safe, however, adequate intraoperative lymph node staging is essential. The aim of this study was to compare the results of a new rapid-IHC system to the HE analysis for intraoperative nodal diagnosis in lung cancer patients considered for segmentectomy. Methods: This retrospective study analyzed the pathological reports from NSCLC resections over a six-year period between 2014 and 2020. Using a new device for rapid-IHC, we applied a high-voltage, low-frequency alternating current (AC) field, which mixes the antipancytokeratin antibody as the voltage is switched on/off. Rapid-IHC can provide a nodal diagnosis within 20 minutes. Results: Frozen sections from 106 resected lymph nodes from 70 patients were intraoperatively evaluated for metastasis. Of those, five nodes were deemed positive based on both HE staining and rapid-IHC. In addition, rapid-IHC alone detected isolated tumor cells in one hilar lymph node. Three cStage IA patients with nodal metastasis detected with HE staining and rapid-IHC received complete lobectomies. Five-year relapse-free survival and overall survival among patients receiving segmentectomy with rapid-IHC were 88.77% and 88.79%, respectively. Conclusions: Rapid-IHC driven by AC mixing is simple, highly accurate, and preserves nodal tissue for subsequent tests. This system can be used effectively for intraoperative nodal diagnosis. Rapid immunohistochemistry based on alternating-current field mixing (completed within 20 minutes) is simple and highly accurate. This system will assist clinicians when making intraoperative diagnoses of lymph node metastasis and deciding upon the appropriate surgical procedure in segmentectomy for lung cancer.

New PET/CT criterion for predicting lymph node metastasis in resectable advanced (stage IB‐III) lung cancer: The standard uptake values ratio of ipsilateral/contralateral hilar nodes

“…One of the reasons is that anatomic segmentectomy for early (≤2 cm) peripheral lung cancer is an oncologically safe and reasonable alternative to lobectomy, but only when there is adequate intraoperative nodal staging, as surgeons cannot complete the segmental/ subsegmental lymph node dissection for the remaining lung segment. 22,23 The new I/C-SUV ratio demonstrated better specificity and should serve as a simple and noninvasive procedure for predicting accurate nodal staging before planning segmentectomy.…”

Utility of mass spectrometry and artificial intelligence for differentiating primary lung adenocarcinoma and colorectal metastatic pulmonary tumor

“…True values were obtained from histopathological examination, while predicted values were obtained from the RF model considered useful for diagnosis of lymph node metastasis in which normal tissue and cancer cells are mixed heterogeneously coexist, and the method has been applied to the rapid diagnosis of regional lymph node metastasis in aggressive reduction surgery for early lung cancer. 15 Actually, R-IHC offers an excellent method of rapid diagnosis that is currently being studied for clinical application. However, some limitations need to be considered, especially the difficulty in distinguishing between thyroid transcription factor-1 (TTF-1)-positive CRMPT and PLAC.…”

“…This approach is considered useful for diagnosis of lymph node metastasis in which normal tissue and cancer cells are mixed heterogeneously coexist, and the method has been applied to the rapid diagnosis of regional lymph node metastasis in aggressive reduction surgery for early lung cancer. 15 …”

Editorial on “robotic versus thoracoscopic combined anatomic subsegmentectomy for early stage lung cancer: early results of a cohort study”

“…We have previously reported the effectiveness of the semi-dry dot-blotting (SDB) method of detecting intraoperative lymph node (LN) metastasis as a quick, costeffective procedure that does not require special technical expertise (12). Moreover, another study described intraoperative LN diagnosis during segmentectomy using rapid immunohistochemistry and noncontact alternating current electric field mixing (13). Second, air-leak management is also important.…”