Lung cancer is the most frequent cause of cancer death in both men and women in the United States. Lymph node staging provides the most important prognostic information in patients with locoregional non-small cell lung cancer (NSCLC). Current methods of evaluating lymph nodes (hematoxylin-eosin staining) can miss micrometastases.
Our first aim i s to establish the utility of an intra-operative gamma probe to detect intravenously injected 18F-Fluorodeoxygulcose (FDG) in thoracic lymph nodes, thus improving the accuracy of lymph node staging in NSCLC. The potential ability of molecular markers to stratify patients with NSCLC into good and poor prognostic groups can alter therapeutic choices for individual patients. Thus, our second aim is to identify biological markers that may predict lymph node metastases (including micrometastases). We intend to achieve these goals by conducting a clinical trial involving 100 patients with resectable NSCLC. All the patients will have a pre-operative positron emission tomogram (PET). The PET-determined stage of the tumor will be compared with the stage determined by the use of an intra-operative gamma probe after intravenous FDG injection. The ability of the gamma probe to guide the detection of micrometastases will be assessed. Routine histologic staining of nodes will be compared to ultrastaging of the lymph node using intensive pathologic techniques. Assays of 4 biomarkers - cyclin B1, cyclin E, survivin and vascular endothelial growth factor (VEGF) - in the primary tumors will be done and correlated with lymph node metastases. This research project will be an integral part of a comprehensive career development program designed to prepare me as an independent patient-oriented investigator. This study is designed to detect microscopic spread of lung cancer to lymph nodes and to molecularly predict the aggressiveness of the cancer. This information will then facilitate therapeutic decisions.
|Nwogu, Chukwumere E; Yendamuri, Sai; Tan, Wei et al. (2013) Lung cancer lymph node micrometastasis detection using real-time polymerase chain reaction: correlation with vascular endothelial growth factor expression. J Thorac Cardiovasc Surg 145:702-7; discussion 707-8|