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

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.


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Lymphatic mapping in testicular cancer after injection of 99mTc-nanocolloid in the left testicle. Early (a) and delayed (b) planar images showing lymphatic tract visualisation and uptake in various lymph nodes along the lymphatic duct. On SPECT/CT with volume rendering (c) three sentinel nodes are indicated (arrows) corresponding to localisations in para-aortic (d), funicular (e) and inguinal (f) basin
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Fig6: Lymphatic mapping in testicular cancer after injection of 99mTc-nanocolloid in the left testicle. Early (a) and delayed (b) planar images showing lymphatic tract visualisation and uptake in various lymph nodes along the lymphatic duct. On SPECT/CT with volume rendering (c) three sentinel nodes are indicated (arrows) corresponding to localisations in para-aortic (d), funicular (e) and inguinal (f) basin

Mentions: The use of SNs in testicular cancer is a relatively new concept and experience with the application is limited [135–138]. All published studies used radiocolloids as SN tracer. In the initial feasibility study by Tanis et al. in 2002, preoperative lymphatic mapping was performed using planar lymphoscintigraphy [135]. While funicular tracer administration showed only lymph node uptake in the inguinal region (which does not reflect the actual testicular tumour drainage pattern), intratesticular administration resulted in visualisation of retroperitoneal SNs in accordance with known drainage patterns. Following these footsteps, a group from Japan demonstrated a detection rate of 95 % in 22 stage I testicular cancer patients in 2005 [137]. Although lymphatic drainage of the testis is mainly directed towards the areas along the aorta and vena cava, aberrant drainage has also been observed [138]. The identification of these SNs in relation to the anatomical structures can be difficult using two-dimensional (2D) lymphoscintigraphy alone. SPECT/CT can provide useful anatomic information about the location of SNs and its improved sensitivity and added third dimension may also lead to the detection of additional SNs (Fig. 6). To date, one study evaluating the use of SPECT/CT for preoperative SN localisation in testicular cancer has been published. SPECT/CT enabled accurate localisation of the SNs and provided anatomical reference points to plan their laparoscopic retrieval [138].Fig. 6


Beyond penile cancer, is there a role for sentinel node biopsy in urological malignancies?
Lymphatic mapping in testicular cancer after injection of 99mTc-nanocolloid in the left testicle. Early (a) and delayed (b) planar images showing lymphatic tract visualisation and uptake in various lymph nodes along the lymphatic duct. On SPECT/CT with volume rendering (c) three sentinel nodes are indicated (arrows) corresponding to localisations in para-aortic (d), funicular (e) and inguinal (f) basin
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037151&req=5

Fig6: Lymphatic mapping in testicular cancer after injection of 99mTc-nanocolloid in the left testicle. Early (a) and delayed (b) planar images showing lymphatic tract visualisation and uptake in various lymph nodes along the lymphatic duct. On SPECT/CT with volume rendering (c) three sentinel nodes are indicated (arrows) corresponding to localisations in para-aortic (d), funicular (e) and inguinal (f) basin
Mentions: The use of SNs in testicular cancer is a relatively new concept and experience with the application is limited [135–138]. All published studies used radiocolloids as SN tracer. In the initial feasibility study by Tanis et al. in 2002, preoperative lymphatic mapping was performed using planar lymphoscintigraphy [135]. While funicular tracer administration showed only lymph node uptake in the inguinal region (which does not reflect the actual testicular tumour drainage pattern), intratesticular administration resulted in visualisation of retroperitoneal SNs in accordance with known drainage patterns. Following these footsteps, a group from Japan demonstrated a detection rate of 95 % in 22 stage I testicular cancer patients in 2005 [137]. Although lymphatic drainage of the testis is mainly directed towards the areas along the aorta and vena cava, aberrant drainage has also been observed [138]. The identification of these SNs in relation to the anatomical structures can be difficult using two-dimensional (2D) lymphoscintigraphy alone. SPECT/CT can provide useful anatomic information about the location of SNs and its improved sensitivity and added third dimension may also lead to the detection of additional SNs (Fig. 6). To date, one study evaluating the use of SPECT/CT for preoperative SN localisation in testicular cancer has been published. SPECT/CT enabled accurate localisation of the SNs and provided anatomical reference points to plan their laparoscopic retrieval [138].Fig. 6

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