Diagnostic Value of the Sentinel Lymph Node Technique in Patients with Muscle-Invasive Bladder Cancer
Background: The optimal limits of the bilateral pelvic lymph node dissection (PLND) template in bladder cancer treatment remain controversial. This study aimed to investigate whether radio-guided sentinel node (SLN) detection is a reliable technique for the perioperative localisation of potential ly...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/9/3092 |
| _version_ | 1797602284319801344 |
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| author | Bartosz Małkiewicz Diana Jędrzejuk Adam Gurwin Karol Wilk Klaudia Knecht-Gurwin Paweł Kiełb Wojciech Krajewski Marek Bolanowski Agnieszka Hałoń Tomasz Szydełko |
| author_facet | Bartosz Małkiewicz Diana Jędrzejuk Adam Gurwin Karol Wilk Klaudia Knecht-Gurwin Paweł Kiełb Wojciech Krajewski Marek Bolanowski Agnieszka Hałoń Tomasz Szydełko |
| author_sort | Bartosz Małkiewicz |
| collection | DOAJ |
| description | Background: The optimal limits of the bilateral pelvic lymph node dissection (PLND) template in bladder cancer treatment remain controversial. This study aimed to investigate whether radio-guided sentinel node (SLN) detection is a reliable technique for the perioperative localisation of potential lymphatic metastasis during cystectomy for muscle-invasive bladder cancer (MIBC). Materials and Methods: We studied 54 patients with pT2-pT4 MIBC who underwent cystectomy with extended PLND (ePLND) augmented by the SLN technique. The identification of SLN was performed by preoperative SPECT/CT hybrid lymphoscintigraphy using peritumoral injection of nanocolloid-Tc-99m, followed by intraoperative navigation with a handheld γ-probe. All nodal specimens were collected separately and then fixed in formalin, stained with haematoxylin and eosin, and examined by an experienced uropathologist. Results: A total of 1414 LNs were resected and examined for the presence of metastases. The mean number of harvested LNs was 26 (range: 11–50) per patient. In 51 of 54 patients, 192 SLNs were resected. In addition, 20/192 (10.4%) SLNs were located outside of the ePLND area. Overall, 72 metastatic LNs (LN+) were found in 22 of 54 patients (40.7%) and in 24/192 SLNs (12.5%). The SLN technique detected LN+ in 14 of 22 (64%) patients. The SLNs were the only sites of metastasis (SLN+ = LN+) in 6 of 22 (27.3%) LN+ patients, including two cases with foci located in the pararectal region. The diagnostic values for the sensitivity, specificity, positive predictive value, and false-negative rate for the SLN technique were 66.66%, 4.16%, 28.57%, and 33.33%, respectively. Extended lymphadenectomy and its combination with the SLN technique enabled the correct assessment in 96.3 and 100% of patients, respectively. Conclusions: The combination of ePLND and SLN provides a better pN assessment compared to ePLND alone. Although the SLN technique has restrictions that limit its diagnostic value, its use as an addition to lymphadenectomy allows for the visualisation of nonstandard lymph drainage pathways that may be potential metastatic routes. |
| first_indexed | 2024-03-11T04:14:57Z |
| format | Article |
| id | doaj.art-2218dc5aa4dc4f1a97da424c5ffcdc6b |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T04:14:57Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-2218dc5aa4dc4f1a97da424c5ffcdc6b2023-11-17T23:10:37ZengMDPI AGJournal of Clinical Medicine2077-03832023-04-01129309210.3390/jcm12093092Diagnostic Value of the Sentinel Lymph Node Technique in Patients with Muscle-Invasive Bladder CancerBartosz Małkiewicz0Diana Jędrzejuk1Adam Gurwin2Karol Wilk3Klaudia Knecht-Gurwin4Paweł Kiełb5Wojciech Krajewski6Marek Bolanowski7Agnieszka Hałoń8Tomasz Szydełko9Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wrocław, PolandDepartment of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, 50-367 Wrocław, PolandDepartment of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wrocław, PolandDepartment of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wrocław, PolandDepartment of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, PolandDepartment of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wrocław, PolandDepartment of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wrocław, PolandDepartment of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, 50-367 Wrocław, PolandDepartment of Clinical and Experimental Pathology, Wrocław Medical University, 50-556 Wrocław, PolandDepartment of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wrocław, PolandBackground: The optimal limits of the bilateral pelvic lymph node dissection (PLND) template in bladder cancer treatment remain controversial. This study aimed to investigate whether radio-guided sentinel node (SLN) detection is a reliable technique for the perioperative localisation of potential lymphatic metastasis during cystectomy for muscle-invasive bladder cancer (MIBC). Materials and Methods: We studied 54 patients with pT2-pT4 MIBC who underwent cystectomy with extended PLND (ePLND) augmented by the SLN technique. The identification of SLN was performed by preoperative SPECT/CT hybrid lymphoscintigraphy using peritumoral injection of nanocolloid-Tc-99m, followed by intraoperative navigation with a handheld γ-probe. All nodal specimens were collected separately and then fixed in formalin, stained with haematoxylin and eosin, and examined by an experienced uropathologist. Results: A total of 1414 LNs were resected and examined for the presence of metastases. The mean number of harvested LNs was 26 (range: 11–50) per patient. In 51 of 54 patients, 192 SLNs were resected. In addition, 20/192 (10.4%) SLNs were located outside of the ePLND area. Overall, 72 metastatic LNs (LN+) were found in 22 of 54 patients (40.7%) and in 24/192 SLNs (12.5%). The SLN technique detected LN+ in 14 of 22 (64%) patients. The SLNs were the only sites of metastasis (SLN+ = LN+) in 6 of 22 (27.3%) LN+ patients, including two cases with foci located in the pararectal region. The diagnostic values for the sensitivity, specificity, positive predictive value, and false-negative rate for the SLN technique were 66.66%, 4.16%, 28.57%, and 33.33%, respectively. Extended lymphadenectomy and its combination with the SLN technique enabled the correct assessment in 96.3 and 100% of patients, respectively. Conclusions: The combination of ePLND and SLN provides a better pN assessment compared to ePLND alone. Although the SLN technique has restrictions that limit its diagnostic value, its use as an addition to lymphadenectomy allows for the visualisation of nonstandard lymph drainage pathways that may be potential metastatic routes.https://www.mdpi.com/2077-0383/12/9/3092sentinel nodelymph node metastasislymphadenectomycystectomybladder cancerSPECT/CT |
| spellingShingle | Bartosz Małkiewicz Diana Jędrzejuk Adam Gurwin Karol Wilk Klaudia Knecht-Gurwin Paweł Kiełb Wojciech Krajewski Marek Bolanowski Agnieszka Hałoń Tomasz Szydełko Diagnostic Value of the Sentinel Lymph Node Technique in Patients with Muscle-Invasive Bladder Cancer Journal of Clinical Medicine sentinel node lymph node metastasis lymphadenectomy cystectomy bladder cancer SPECT/CT |
| title | Diagnostic Value of the Sentinel Lymph Node Technique in Patients with Muscle-Invasive Bladder Cancer |
| title_full | Diagnostic Value of the Sentinel Lymph Node Technique in Patients with Muscle-Invasive Bladder Cancer |
| title_fullStr | Diagnostic Value of the Sentinel Lymph Node Technique in Patients with Muscle-Invasive Bladder Cancer |
| title_full_unstemmed | Diagnostic Value of the Sentinel Lymph Node Technique in Patients with Muscle-Invasive Bladder Cancer |
| title_short | Diagnostic Value of the Sentinel Lymph Node Technique in Patients with Muscle-Invasive Bladder Cancer |
| title_sort | diagnostic value of the sentinel lymph node technique in patients with muscle invasive bladder cancer |
| topic | sentinel node lymph node metastasis lymphadenectomy cystectomy bladder cancer SPECT/CT |
| url | https://www.mdpi.com/2077-0383/12/9/3092 |
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