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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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Following administration of the hybrid tracer ICG-99mTc-nanocolloid in both lobes of the prostate, transversal SPECT/CT (a) shows iliac and presacral sentinel nodes, which are subsequently removed by means of a robot-assisted procedure (b–d)
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Fig4: Following administration of the hybrid tracer ICG-99mTc-nanocolloid in both lobes of the prostate, transversal SPECT/CT (a) shows iliac and presacral sentinel nodes, which are subsequently removed by means of a robot-assisted procedure (b–d)

Mentions: In recent years, fluorescent dyes are increasingly being used during SN dissection in prostate cancer. These tracers are also injected intraprostatically and allow for realtime visualization of SNs and their afferent lymphatic vessels. One of the benefits of this approach can be that whereas intraoperative SN localisation using radiocolloid-based techniques can sometimes be hampered when SNs are located near the prostatic injection site (because of the high radioactive background signal), fluorescence-based techniques do not suffer from this limitation due to the relatively high resolution of fluorescence imaging systems. The most frequently used fluorescent dye has been ICG [86]. Using ICG in its free form has the benefit of rapid migration into the lymph nodes draining the prostate after intraprostatic injection [87]. Retention of tracer in lymph nodes, however, is much lower than with the use of nanocolloid bound ICG. Therefore, injection of free ICG is applied briefly (10–30 min) prior to the nodal dissection. This may provide logistical benefits compared to radiocolloid based tracing (no radioactivity, no preoperative scans), which may partially explain its increasing popularity [54]. However, although free ICG seems to provide a practical alternative gamma tracing, it does not allow for preoperative SPECT/CT and as a consequence, alternative lymph draining patterns may be missed due to the low penetrance of the NIR signal of ICG [88]. Studies using ICG bound to nanocolloid have also been performed and have shown to retain the properties of the original radiocolloid exhibiting longer retention times in the lymph nodes and allowing for combined pre- and perioperative imaging in open/laparoscopic procedures (Fig. 4) [34, 48, 75].Fig. 4


Beyond penile cancer, is there a role for sentinel node biopsy in urological malignancies?
Following administration of the hybrid tracer ICG-99mTc-nanocolloid in both lobes of the prostate, transversal SPECT/CT (a) shows iliac and presacral sentinel nodes, which are subsequently removed by means of a robot-assisted procedure (b–d)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC5037151&req=5

Fig4: Following administration of the hybrid tracer ICG-99mTc-nanocolloid in both lobes of the prostate, transversal SPECT/CT (a) shows iliac and presacral sentinel nodes, which are subsequently removed by means of a robot-assisted procedure (b–d)
Mentions: In recent years, fluorescent dyes are increasingly being used during SN dissection in prostate cancer. These tracers are also injected intraprostatically and allow for realtime visualization of SNs and their afferent lymphatic vessels. One of the benefits of this approach can be that whereas intraoperative SN localisation using radiocolloid-based techniques can sometimes be hampered when SNs are located near the prostatic injection site (because of the high radioactive background signal), fluorescence-based techniques do not suffer from this limitation due to the relatively high resolution of fluorescence imaging systems. The most frequently used fluorescent dye has been ICG [86]. Using ICG in its free form has the benefit of rapid migration into the lymph nodes draining the prostate after intraprostatic injection [87]. Retention of tracer in lymph nodes, however, is much lower than with the use of nanocolloid bound ICG. Therefore, injection of free ICG is applied briefly (10–30 min) prior to the nodal dissection. This may provide logistical benefits compared to radiocolloid based tracing (no radioactivity, no preoperative scans), which may partially explain its increasing popularity [54]. However, although free ICG seems to provide a practical alternative gamma tracing, it does not allow for preoperative SPECT/CT and as a consequence, alternative lymph draining patterns may be missed due to the low penetrance of the NIR signal of ICG [88]. Studies using ICG bound to nanocolloid have also been performed and have shown to retain the properties of the original radiocolloid exhibiting longer retention times in the lymph nodes and allowing for combined pre- and perioperative imaging in open/laparoscopic procedures (Fig. 4) [34, 48, 75].Fig. 4

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