A novel method for sentinel lymph node mapping using magnetite in patients with non-small cell lung cancer

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Objective: The detection rate of sentinel lymph nodes in patients with non-small cell lung cancer using isosulfan blue dye is too low for clinical use. Although exposure to radioactivity is reportedly minimal, special procedures are nonetheless required when a radioactive isotope is used as a tracer. Therefore, to eliminate the need for a radioactive tracer and to obtain a better detection rate than is obtained with isosulufan blue dye, we have developed a novel method that employs magnetite as the tracer. The aim of the present study was to test the feasibility of this technique.Methods: The tracer employed was ferumoxides, a colloidal superparamagnetic iron oxide of nonstoichiometric magnetite. Thirty-eight non-small cell lung cancer patients participated in the study; each received 5 ml of ferumoxides, injected around the tumor intraoperatively. Fifteen minutes after injection, lung resection and lymph node dissection was carried out The magnetic force within the lymph nodes was measured using a highly sensitive hand-held magnetometer ex vivo. All lymph nodes were also subjected to conventional histological analysis.Results: The rate of detection of sentinel lymph nodes was 81.6% (31/38). The accuracy, sensitivity and false-negative rates were 96.8% (30/31), 85.7% (6/7) and 14.3% (1/7), respectively.Conclusion: Intraoperative sentinel lymph node mapping using ferumoxides and a highly sensitive magnetometer is a safe, accurate, and sensitive way to detect sentinel Jymph nodes in non-small cell lung cancer patients.