Sentinel Node Mapping in Lung Cancer: The Japanese Experience

The reduction in lymph node dissection using sentinel node (SN) identification in patients with lung cancer is associated with several difficulties, compared with similar procedures in patients with breast cancer or melanoma. To overcome the difficulties of SN identification in lung cancer, several topics have been reported in Japan. In this study, the following topics regarding SN identification in lung cancer patients will be introduced: (1) devices for SN identification using a radioisotope tracer; (2) movement of Tc-99 tin colloid after injection; (3) characteristics of patients in whom SNs could not be identified; (4) results of ex vivo SN identification; (5) reliability of in vivo SN identification; (6) algorithm for reducing mediastinal lymph node dissection; (7) SN identification using SPECT/CT; (8) differences in SN identification between large and small radioisotope particles; (9) size of metastatic and nonmetastatic mediastinal lymph nodes in non-small cell lung cancer; (10) SN navigation segmentectomy for clinical stage IA non-small cell lung cancer; and (11) lymphatic flow at segmental lymph nodes.