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Beyond penile cancer, is there a role for sentinel node biopsy in urological malignancies?

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ABSTRACT

This review aims to discuss the current state-of-the-art of sentinel node (SN) mapping in urological malignancies. The principles and methodological aspects of lymphatic mapping and SN biopsy in urological malignancies are reviewed. Literature search was restricted to English language. The references of the retrieved articles were examined to identify additional articles. The review also includes meta-analyses published in the past 5 years. SN biopsy for penile cancer is recommended by the European Association of Urology as the preferred staging tool for clinically node-negative patients with at least T1G2 tumours (level of evidence 2a, Grade B). The feasibility of SN biopsy in prostate cancer has been repeatedly demonstrated and its potential value is increasingly being recognised. However, conclusive prospective clinical data as well as consensus on methodology and patient selection are still lacking. For bladder, renal and testicular cancer, only few studies have been published, and concerns around high false-negative rates remain. Throughout the years, the uro-oncological field has portrayed a pivotal role in the development of the SN concept. Recent advances such as hybrid tracers and novel intraoperative detection tools such as fluorescence and portable gamma imaging will hopefully encourage prospectively designed clinical trials which can further substantiate the potential of the SN approach in becoming an integral part of staging in urological malignancies beyond penile cancer.

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Anatomical sentinel node (SN) distribution. In penile cancer (a) SNs are limited to the groin and are predominantly found in the superior and central inguinal Daseler’s zones [28]. In contrast, prostate cancer (b) SN locations concern different pelvic basins (white caption) according to Wawroschek F et al. [65] as well as in other less common sites (green captions) according to Meinhardt W et al. (Prostate Cancer 2012;2012:751–3)
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Fig1: Anatomical sentinel node (SN) distribution. In penile cancer (a) SNs are limited to the groin and are predominantly found in the superior and central inguinal Daseler’s zones [28]. In contrast, prostate cancer (b) SN locations concern different pelvic basins (white caption) according to Wawroschek F et al. [65] as well as in other less common sites (green captions) according to Meinhardt W et al. (Prostate Cancer 2012;2012:751–3)

Mentions: A sentinel node (SN) is defined as any lymph node on a direct drainage pathway from the primary tumour. This definition reflects the physiology of lymphatic drainage and the stepwise dissemination of cancer to a regional lymph node basin; it also acknowledges the possibility that more than one lymph node can be directly connected with the tumour and thus be a potential first site to harbour metastases before further progression to so called higher-tier/higher-echelon nodes [1]. With the introduction of the SN concept, a minimally invasive diagnostic modality emerged for early detection of occult lymph node metastases. Since its introduction more than 20 years ago for melanoma and breast cancer, the SN procedure has gone through a major development process and has become an essential component of lymph node staging in penile cancer [2, 3]. Consequently, this has led to an increasing interest in the application of the SN concept in other urological malignancies. Although both preoperative lymphatic mapping and intraoperative SN detection are common parts of the SN procedure for urological tumours, injection techniques and lymphatic drainage patterns may differ. In penile cancer, lymphatic drainage is mainly superficial and the first draining lymph nodes are usually located in the groin. In contrast, lymphatic drainage in prostate cancer and other urological tumours is deep and SNs are often found along the iliac vessels as well as in other complex anatomical areas (Fig. 1). This article covers the principles and methodological aspects of lymphatic mapping and SN biopsy in urological malignancies. The original introduction and evolution of the SN procedure in penile cancer is reviewed, as well as its potential role in prostate, bladder, renal and testicular cancer.Fig. 1


Beyond penile cancer, is there a role for sentinel node biopsy in urological malignancies?
Anatomical sentinel node (SN) distribution. In penile cancer (a) SNs are limited to the groin and are predominantly found in the superior and central inguinal Daseler’s zones [28]. In contrast, prostate cancer (b) SN locations concern different pelvic basins (white caption) according to Wawroschek F et al. [65] as well as in other less common sites (green captions) according to Meinhardt W et al. (Prostate Cancer 2012;2012:751–3)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5037151&req=5

Fig1: Anatomical sentinel node (SN) distribution. In penile cancer (a) SNs are limited to the groin and are predominantly found in the superior and central inguinal Daseler’s zones [28]. In contrast, prostate cancer (b) SN locations concern different pelvic basins (white caption) according to Wawroschek F et al. [65] as well as in other less common sites (green captions) according to Meinhardt W et al. (Prostate Cancer 2012;2012:751–3)
Mentions: A sentinel node (SN) is defined as any lymph node on a direct drainage pathway from the primary tumour. This definition reflects the physiology of lymphatic drainage and the stepwise dissemination of cancer to a regional lymph node basin; it also acknowledges the possibility that more than one lymph node can be directly connected with the tumour and thus be a potential first site to harbour metastases before further progression to so called higher-tier/higher-echelon nodes [1]. With the introduction of the SN concept, a minimally invasive diagnostic modality emerged for early detection of occult lymph node metastases. Since its introduction more than 20 years ago for melanoma and breast cancer, the SN procedure has gone through a major development process and has become an essential component of lymph node staging in penile cancer [2, 3]. Consequently, this has led to an increasing interest in the application of the SN concept in other urological malignancies. Although both preoperative lymphatic mapping and intraoperative SN detection are common parts of the SN procedure for urological tumours, injection techniques and lymphatic drainage patterns may differ. In penile cancer, lymphatic drainage is mainly superficial and the first draining lymph nodes are usually located in the groin. In contrast, lymphatic drainage in prostate cancer and other urological tumours is deep and SNs are often found along the iliac vessels as well as in other complex anatomical areas (Fig. 1). This article covers the principles and methodological aspects of lymphatic mapping and SN biopsy in urological malignancies. The original introduction and evolution of the SN procedure in penile cancer is reviewed, as well as its potential role in prostate, bladder, renal and testicular cancer.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

This review aims to discuss the current state-of-the-art of sentinel node (SN) mapping in urological malignancies. The principles and methodological aspects of lymphatic mapping and SN biopsy in urological malignancies are reviewed. Literature search was restricted to English language. The references of the retrieved articles were examined to identify additional articles. The review also includes meta-analyses published in the past 5 years. SN biopsy for penile cancer is recommended by the European Association of Urology as the preferred staging tool for clinically node-negative patients with at least T1G2 tumours (level of evidence 2a, Grade B). The feasibility of SN biopsy in prostate cancer has been repeatedly demonstrated and its potential value is increasingly being recognised. However, conclusive prospective clinical data as well as consensus on methodology and patient selection are still lacking. For bladder, renal and testicular cancer, only few studies have been published, and concerns around high false-negative rates remain. Throughout the years, the uro-oncological field has portrayed a pivotal role in the development of the SN concept. Recent advances such as hybrid tracers and novel intraoperative detection tools such as fluorescence and portable gamma imaging will hopefully encourage prospectively designed clinical trials which can further substantiate the potential of the SN approach in becoming an integral part of staging in urological malignancies beyond penile cancer.

No MeSH data available.


Related in: MedlinePlus