Lymphatic Drainage from Renal Tumors In Vivo: A Prospective Sentinel Node Study Using SPECT/CT Imaging

Kuusk, Teele; Bruijn, Roderick de; Brouwer, Oscar R.; Jong, Jeroen de; Donswijk, Maarten L.; Grivas, Nikolaos; Hendricksen, Kees; Horenblas, Simon; Prevoo, Warner; Olmos, Renato A. Valdés; Poel, Henk G. van der; Wit, Esther; Bex, Axel

doi:10.1016/j.juro.2017.11.112

Cited by 35 publications

(32 citation statements)

References 26 publications

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“…Third, the study highlights the unpredictable variability of lymphatic drainage from RCC (4,14). As previously © Annals of Translational Medicine.…”

supporting

confidence: 51%

Beyond the predictors of lymph node metastases in patients undergoing lymph node dissection for renal cell carcinoma: the impact of tumour side and location

et al. 2019

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“…Third, the study highlights the unpredictable variability of lymphatic drainage from RCC (4,14). As previously © Annals of Translational Medicine.…”

supporting

confidence: 51%

Beyond the predictors of lymph node metastases in patients undergoing lymph node dissection for renal cell carcinoma: the impact of tumour side and location

et al. 2019

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“…One multicenter randomized-controlled trial (RCT) was included (15). Only two studies were specifically designed to evaluate the pattern of lymphatic drainage from RCC by using sequential lymphoscintigraphy and sentinel node (SN) biopsy (30, 37). No study compared LN yield, cancer control and surgical complications of extended vs. limited LND.…”

Section: Resultsmentioning

confidence: 99%

“…The overall number of LNs removed at the time of surgery (10, 19, 22–25, 28–34, 36–39), as well as the proportion of positive LNs, were reported by the majority of included studies, despite the latter was highly variable across the included studies (range 0–56,8%) (Table 1). Of note, only a minority of reports described the specific anatomic location (and number) of positive nodes (19, 25, 28, 30, 34, 37–39). All included studies reported a side- specific anatomical template of LND, with description of the anatomical boundaries and upper/lower limits of dissection; yet, indications and extent (i.e., standard vs. extended) of LND were either not reported or not standardized in most series.…”

Section: Resultsmentioning

confidence: 99%

“…For right-sided tumors, the LND template included in most cases the hilar, paracaval (on the lateral side of the vena cava), and precaval (i.e., on the anterior side of the vena cava) nodes, from the crus of the diaphragm to the aortic bifurcation (Table 1). Some authors reported the dissection of a more extended template including the inter-aortocaval (8, 15, 19, 20, 25, 28–30, 32–35, 37, 39), retrocaval (8, 15, 19–21, 23, 27, 29, 32, 35, 37, 38), common iliac (25) nodes or even pre/paraaortic nodes (19). In their retrospective study on the outcomes of laparoscopic radical nephrectomy with or without LND, Chapman et al included the removal of inter-aortocaval and retrocaval nodes only in the last group of patients included in the series (25).…”

Section: Resultsmentioning

confidence: 99%

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Templates of Lymph Node Dissection for Renal Cell Carcinoma: A Systematic Review of the Literature

et al. 2018

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Background: The role of lymph node dissection (LND) for renal cell carcinoma (RCC) is controversial. Notably, the conflicting evidence on the benefits and harms of LND is inherently linked to the lack of consensus on both anatomic templates and extent of lymphadenectomy. Herein, we provide a detailed overview of the most commonly dissected templates of LND for RCC, focusing on key anatomic landmarks and patterns of lymphatic drainage.Methods: A systematic review of the English-language literature was performed without time filters in July 2018 in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement recommendations. The primary endpoint was to summarize the most commonly dissected templates of LND according to the side of RCC.Results: Overall, 25 studies were selected for qualitative analysis. Of these, most were retrospective. The LND template was heterogeneous across studies. Indications and extent of LND were either not reported or not standardized in most series. The most commonly dissected template for right-sided tumors included hilar, paracaval, and precaval nodes, with few authors extending the dissection to the inter-aortocaval, retrocaval, common iliac or pre/paraaortic nodes. Similarly, the most commonly dissected template for left-sided tumors encompassed the renal hilar, preaortic and paraaortic nodes, with few authors reporting a systematic dissection of inter-aortocaval, retro-aortic, common iliac, or para-caval nodes.Conclusions: In light of the unpredictable renal lymphatic anatomy and the evidence from available prospective mapping studies, the extent of the most commonly dissected templates might be insufficient to catch the overall anatomic pattern of lymphatic drainage from RCC.

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“…In a prospective phase II trial, by Kuusk et al 225 MBq of 99mTc-nanocolloid was injected under ultrasound guidance into renal tumors <10 cm 1 day prior to surgery ( 101 ). Early dynamic imaging after 20 min and lymphoscintigraphy after 2–4 h and SPECT/CT were performed.…”

Section: Renal 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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Lymphatic Drainage from Renal Tumors In Vivo: A Prospective Sentinel Node Study Using SPECT/CT Imaging

Abstract: Sentinel nodes from renal tumors were mainly located in the respective locoregional retroperitoneal templates. Simultaneous sentinel nodes were located outside the suggested lymph node dissection templates, including supradiaphragmatic sentinel nodes in more than a third of the patients.

Cited by 35 publications

References 26 publications

Beyond the predictors of lymph node metastases in patients undergoing lymph node dissection for renal cell carcinoma: the impact of tumour side and location

Beyond the predictors of lymph node metastases in patients undergoing lymph node dissection for renal cell carcinoma: the impact of tumour side and location

Templates of Lymph Node Dissection for Renal Cell Carcinoma: A Systematic Review of the Literature

Sentinel lymph node imaging in urologic oncology

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