The effect of one-lung ventilation on sentinel lymph node mapping in dog lungs.

Delay one-lung ventilation during NIRF-guided SLN mapping to improve ICG detection accuracy in canine lung.

This prospective, randomized experimental study evaluated sentinel lymph node (SLN) mapping in the caudal lung lobes of 21 purpose-bred Beagles using indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging via lateral intercostal thoracoscopy. Dogs were randomized to receive ICG injections into the right or left caudal lung lobe under either one-lung ventilation (OLV) or normal ventilation (NV). A fluorescent lymph node was identified in 90% of dogs, with the tracheobronchial lymph node being the most common draining lymph node (79% of cases). However, drainage patterns were variable; in 21% of dogs, the first fluorescent lymph node detected was the central tracheobronchial, sternal, cranial mediastinal lymph node, or a combination thereof. Six dogs demonstrated simultaneous fluorescence in multiple lymph nodes. A significant difference in time to fluorescence was observed between groups: median detection time was 30 minutes under OLV versus 10 minutes under NV (p = .0012), indicating that OLV substantially slows lymphatic ICG transit. The authors conclude that assuming the tracheobronchial lymph node is the universal SLN for caudal lung tumors without performing NIRF-guided mapping may result in inaccurate staging in a meaningful proportion of cases. Clinically, delaying OLV induction until after ICG has reached the SLN may improve detection accuracy during thoracoscopic procedures in dogs with suspected pulmonary neoplasia.

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