Sentinel Node Microscopic Metastasis Detected after Segmentectomy for Lung Cancer Followed by Completion Lobectomy: Two Case Reports

Abstract

We performed sentinel node identification using radioisotopic and/or dye techniques to determine the final indication after segmentectomy in cases with non-small cell lung cancer. Sentinel nodes were examined using intraoperative frozen sections stained with hematoxylin and eosin. We present 2 cases with completion lobectomy performed 7 and 11 days after segmentectomy because immunohistochemical staining of the sentinel nodes showed the presence of microscopic metastases that were not detected by the examination of intraoperative frozen sections.

Strategies of Lymph Node Dissection During Sublobar Resection for Early-Stage Lung Cancer

“…One can even say that the level of exigency should be even higher because of the potential for overlooking iLNs. This leads us to make the following recommendations, which are not our own but those inspired by surgeons and expert centers that have been cited in this article (11,17,18,23,26,27,29,40):…”

“…The reasons for the possible inferiority of SLR compared to lobectomy, at least in some cohort studies, are the following (and these reasons can be correlated): (1) some SLRs are actually wedge resections, (2) insufficient resection margins, (3) low number of nodes being examined, (4) absence of analysis of the so-called "adjacent" nodes and (5) non-practice of frozen section on margins and on the segmental nodes, which does not allow for extension to lobectomy during the procedure (Positivity nodes on final pathological examination rarely leads to a reoperation). All in all, as emphasized by P. Thomas, lymph node dissection might be the key point in performing a "radical segmentectomy" (17).…”