Dynamic sentinel lymph node biopsy for penile cancer: a comparison between 1‐ and 2‐day protocols

Dimopoulos, Panagiotis; Christopoulos, Panagiotis; Shilito, S; Gall, Zara; Murby, Brian; Ashworth, D. R.; Taylor, Benjamin; Carrington, Bernadette M; Shanks, Jonathan H; Clarke, Noel W.; Ramani, Vijay; Parr, Nigel J.; Lau, Maurice; Sangar, Vijay K

doi:10.1111/bju.13389

Cited by 35 publications

(23 citation statements)

References 9 publications

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“…Based on this modernised concept, the SN procedure was re-introduced in uro-oncology in 1994 when Horenblas et al initiated studies in the Netherlands applying the SN biopsy in its current form in penile cancer patients [ 9 ]. Since then, the procedure has evolved into a reliable staging technique, with a low complication rate compared to (prophylactic) inguinal lymphadenectomy [ 10 – 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…Repeat SN biopsy after tumour recurrence is also a validated procedure [ 19 ]. Lymphoscintigraphy after radiocolloid injection is mostly performed at 10–20 min and 2 h postinjection [ 12 , 15 ]. The most frequently visualised lymphatic drainage pattern is bilateral drainage to both groins (80 %) and this technique has a reproducibility rate of 100 % [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

“…As is customary for SN biopsy in melanoma and breast cancer, intraoperative SN detection is guided by a gamma-ray detection probe and blue dye. The entire (pre- and intraoperative) procedure can be performed in both 1- and 2-day protocols, although a 1-day protocol may yield lower false-negative rates [ 12 ]. Proper pathological node examination is imperative to minimise false-negative results.…”

Section: Methodsmentioning

confidence: 99%

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

Brouwer

Poel

Bevers

et al. 2016

Clin Transl Imaging

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This review aims to discuss the current state-ofthe-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 urooncological 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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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Brouwer

Poel

Bevers

et al. 2016

Clin Transl Imaging

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“…The present article by Dimopoulos et al. has some useful lessons on the development of new services. The authors have kept a detailed database of all patients going through their super‐regional network, and have designed the protocol around the patient, whereby the primary and regional lymph nodes are dealt with in one visit.…”

mentioning

confidence: 86%

One‐day protocol appears safe for managing the primary tumour and regional nodes in penile cancer

Hegarty

Lonergan

2016

BJU International

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“…This modernized concept is a combination of different techniques with the goal to visualize the sentinel LN(s) prior and during the procedure to ensure that all positive LNs are removed and histopathologically evaluated ( 2 ). In Europe, current workflow consists of intradermal injection of 0.2–0.4 mL of 99mTechnetium (99mTc)-nanocolloid corresponding to 50–90 MBq proximal to the primary tumor 4 hours to 1 day prior to surgery ( 36 ). This can be done even after the primary tumor is removed by injecting around the surgical scar ( 37 ).…”

Section: Penile Cancermentioning

confidence: 99%

Sentinel lymph node imaging in urologic oncology

Mehralivand

Poel

Winter³

et al. 2018

Transl. Androl. Urol

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Lymph node (LN) metastases in urological malignancies correlate with poor oncological outcomes. Accurate LN staging is of great importance since patients can benefit from an optimal staging, accordingly aligned therapy and more radical treatments. Current conventional cross-sectional imaging modalities [e.g., computed tomography (CT) and magnetic resonance imaging (MRI)] are not accurate enough to reliably detect early LN metastases as they rely on size criteria. Radical lymphadenectomy, the surgical removal of regional LNs, is the gold standard of invasive LN staging. The LN dissection is guided by anatomic considerations of lymphatic drainage pathways of the primary tumor. Selection of patients for lymphadenectomy heavily relies on preoperative risk stratification and nomograms and, as a result a considerable number of patients unnecessarily undergo invasive staging with associated morbidity. On the other hand, due to individual variability in lymphatic drainage, LN metastases can occur outside of standard lymphadenectomy templates leading to potential understaging and undertreatment. In theory, metastases from the primary tumor need to pass through the chain of LNs, where the initial node is defined as the sentinel LN. In theory, identifying and removing this LN could lead to accurate assessment of metastatic status. Radiotracers and more recently fluorescent dyes and superparamagnetic iron oxide nanoparticles (SPION) are injected into the primary tumor or peritumoral and the sentinel LNs are identified intraoperatively by a gamma probe, fluorescent camera or a handheld magnetometer. Preoperative imaging [e.g., single-photon emission computed tomography (SPECT)/CT or MRI] after tracer injection can further improve preoperative planning of LN dissection. While sentinel LN biopsy is an accepted and widely used approach in melanoma and breast cancer staging, its use in urological malignancies is still limited. Most data published so far is in penile cancer staging since this cancer has a typical echelon-based lymphatic metastasizing pattern. More recent data is encouraging with low false-negative rates, but its use is limited to centers with high expertise. Current guidelines recommend sentinel LN biopsy as an accepted alternative to modified inguinal lymphadenectomy in patients with pT1G2 disease and non-palpable inguinal LNs. In prostate cancer, a high diagnostic accuracy could be demonstrated for the sentinel approach. Nevertheless, due to lack of data or high false-negative rates in other urological malignancies, sentinel LN biopsy is still considered experimental in other urological malignancies. More high-level evidence and longitudinal data is needed to determine its final value in those malignancies. In this manuscript, we will review sentinel node imaging for urologic malignancies.

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Dynamic sentinel lymph node biopsy for penile cancer: a comparison between 1‐ and 2‐day protocols

Cited by 35 publications

References 9 publications

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

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

One‐day protocol appears safe for managing the primary tumour and regional nodes in penile cancer

Sentinel lymph node imaging in urologic oncology

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