Preclinical feasibility of bronchoscopic fluorescence-guided lung sentinel lymph node mapping

Area of Science:

• Pulmonology
• Surgical Oncology
• Medical Imaging

Background:

• Sentinel lymph node mapping is crucial for identifying the primary sites of metastasis in lung cancer.
• Accurate lymph node staging is essential for effective treatment planning and patient outcomes.

Purpose of the Study:

• To evaluate the preclinical feasibility of bronchoscopic fluorescence-guided sentinel lymph node mapping in pigs.
• To assess the efficacy of an ultrathin composite fiberscope for detecting fluorescently labeled sentinel lymph nodes.

Main Methods:

• Healthy Yorkshire pigs underwent transbronchial injection of indocyanine green (ICG).
• Sentinel lymph node mapping was performed using an ultrathin composite fiberscope via the bronchoscope working channel.
• Fluorescence imaging was validated with rigid bronchoscopy and mediastinoscopy.

Main Results:

• Indocyanine green injection produced strong, detectable fluorescence within 10 minutes.
• The ultrathin composite fiberscope demonstrated concordance with other imaging methods.
• Fluorescence-guided transbronchial needle aspiration successfully obtained fluorescent material, correlating with specimen adequacy.

Conclusions:

• Bronchoscopic fluorescence-guided sentinel lymph node mapping is a feasible preclinical technique.
• Real-time fluorescence feedback enhances sentinel lymph node biopsy success.
• Minimizing indocyanine green leakage is critical for clinical translation.