Intraoperative Contrast-Enhanced Ultrasound to Assess Lymph Node Resection and Involvement in Patients Undergoing Robotic-Assisted Thoracic Surgery Lobectomy for Management of Non-Small Cell Lung Cancer.

BACKGROUND: Mediastinal staging is crucial in patients undergoing lung resection for cancer to plan further adjuvant. Current guidelines recommend resecting at least three mediastinal lymph node stations, including Group7. Herein, we evaluated the role of intraoperative Contrast-enhanced ultrasound (CEUS) to guide lymph node resection in patients undergoing RATS lobectomy for management of non-small cell lung cancer. METHODS: It was a retrospective study including 24 consecutive patients underwent RATS lobectomy for management lung cancer. The hilar and mediastinal lymph node was firstly evaluated with a CEUS and then resected. A bolus of 2.4 mL SonoVue was injected into the antecubital vein and the perfusion was scanned continuously for at least 3 min. The dynamic image obtained was used to evaluate the mediastinal and hilar lymph nodal and guide the dissection. A radical lymph-adenectomy was performed in all cases independently from the CEUS results. RESULTS: We evaluated 144 lymph nodes with a CEUS during RATS lobectomy. Histological examination of the lymph nodes showed five lymph nodes metastatic (3.5%); of which 3 (60%) metastatic N1 lymph nodes; 2 (40%) metastatic N2 lymph nodes. Intraoperative CEUS of hilar and mediastinal lymph nodes showed: sensitivity 83%; specificity 98%; PPV, 77%; PNV, 99% and accuracy 94%. CONCLUSION: Our preliminary results seem to confirm the value of intraoperative CEUS to assess lymph node resection during RATS lobectomy. It may help the lymph node dissection and reduce the risk of intraoperative injury. Future study should confirm our preliminary results and confirm the value of intraoperative CEUS.