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Purpose. To assess the loco-regional distribution pattern of a blue dye tracer, as a surrogate for a chemotherapeutic agent, injected in the invasion edge of resectable lung tumor; to evaluate the technique efficacy at staining the lung-tumor interface and the metastatic pathways. Methods. Between November 2014 and September 2015, we enrolled 33 patients (17 women, 16 men; 5287 years old) presenting with 31 primary lung carcinomas and 2 metastases. We injected in vivo (n=17) or ex vivo (n=16) the innermost side of the tumor invasion edge with 1.3ml methylene blue dye. We performed the injection alone (n=12) or combined with a focal freezing (n=21). We assessed the stain distribution into the invasion-edge, the tumor, the lung or the node(s) at gross and microscopic examination. Results. At gross examination, we observed a quick, intense staining of the invasion edge, and a concomitant staining of the tumor and the lung. The staining pattern was heterogeneous in the tumor, homogeneous in the invasion edge and the lung irrespective of the focal freezing, tumor type, size, or blood perfusion status. The microscopic examination evidenced the staining of the matrix, vessel lumens, and tumor cells, except for lymph nodes. Conclusions. The inner side of the invasion edge looks a suitable location for directly injecting and distributing the methylene blue tracer within the interstitium and related draining pathways during the resection of primary or secondary lung tumor. Fresh resection specimens are convenient to evaluate new edge-targeting injections techniques for the diagnostic or therapeutic management of cell dissemination during surgery.

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THE BI-DIRECTIONAL MIGRATION OF A DYE TRACER INJECTED AT THE EDGE OF PRIMARY OR SECONDARY LUNG TUMORS DURING SURGERY (INITIAL STUDY ON 33 PATIENTS AND CLINICAL IMPLICATIONS)