Recommendation for a sentinel lymph node procedure in early-stage non-small cell lung cancer

To improve survival and enhance the prognosis of lung cancer patients, early detection of malignant lung nodules is essential. A procedure used to diagnose non-small cell lung cancer (NSCLC) is navigation bronchoscopy. However, navigation bronchoscopy has limitations regarding the examination of peripheral sentinel lymph nodes (SLNs). The overarching aim of this Technisch Geneeskundige Opdracht (TGO) is to describe a protocol for a SLN procedure in NSCLC. In a SLN procedure, a contrast agent is injected peritumorally to visualize the draining lymph nodes of a tumor. Navigation bronchoscopy is useful for administering this injection, as the tumor site has already been reached. Possible contrast agents and imaging modalities for a SLN procedure in NSCLC are described, based on protocols in other types of cancer and studies in NSCLC. Currently, 99mTc is the most used contrast agent for SLN procedures, and its usage has achieved great results. In NSCLC, 99mTc is also a promising agent. Therefore, an advised protocol using 99mTc-HSA is given, which can be used in further research or clinical trials in the longer term.