Bronchoscopic radioisotope injection for sentinel lymph-node mapping in potentially resectable non-small-cell lung cancer. 
Prospective study to evaluate the feasibility of a preoperative bronchoscopic radioisotope application, followed by conventional sentinel lymph-node (SLN) identification and to investigate the occurrence and distribution of micrometastases in relation to SLN activity.  Twenty patients with a mean age of 63 years and proven clinical stage T1-3 N0-1 non-small-cell lung cancer (NSCLC) were included.  A dosage of 80MBq radiolabeled technetium-99m nanocolloid was endoscopically administrated on intubated patients in the operation theatre.  At thoracotomy, scintigraphic readings of both the primary tumor and hilar and mediastinal lymph-node stations were obtained with a hand-held gamma-counter.  Patients underwent lung resection and mediastinal lymphadenectomy.  Radiolabeled nodes were also examined separately on back-table.  SLNs were defined as the hottest nodes or nodes with at least one-tenth of the radioactivity of the hottest nodes.  SLNs pathologic assessment included standard examination using hematoxylin and eosin staining on step sections and immunohistochemistry (ICH) for cytokeratins.  Identification of SLNs was possible in 19/20 (95%) patients after bronchoscopic radioisotope application.  In 7/19 (37%) patients, a unique SLN was identified, whereas in 12/19 (63%) patients, nodes from two different stations could be classified as SLNs.  Metastatic nodal disease was found in 9/19 (47%) patients.  ICH revealed micrometastases in 2/12 (17%) patients, initially classified nodal negative.  Pathologic negative SLNs were a predictor for absence of metastatic nodal disease after mediastinal lymphadenectomy.  No complication related to the procedure was observed.  Our preliminary results suggest that preoperative bronchoscopic radioisotope injection for SLN identification is a safe and simple method, improving accuracy of SLN detection in comparison to intraoperative technique.  The absence of metastases in the SLNs seems to predict a negative nodal status accurately.