Sentinel node detection in renal cell carcinoma. A feasibility study for detection of tumour‐draining lymph nodes

• Published in: BJU international Vol. 109; no. 8; pp. 1134 - 1139
• Main Authors: Sherif, Amir M., Eriksson, Elisabeth, Thörn, Magnus, Vasko, Janos, Riklund, Katrine, Öhberg, Lars, Ljungberg, Börje J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2012; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Abdomen; Aged; Biological and medical sciences; Biopsy; Carcinoma, Renal Cell - diagnosis; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - surgery; Diagnosis, Differential; Feasibility Studies; Female; Follow-Up Studies; Humans; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidneys; lymph node staging; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic Metastasis; Male; Medical research; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Neoplasm Staging - methods; Nephrectomy; Nephrology. Urinary tract diseases; Prospective Studies; radio-guided surgery; Radiography; Radionuclide Imaging; renal cell carcinoma; Reproducibility of Results; Sentinel Lymph Node Biopsy - methods; sentinel node; single photon emission computed tomography; Tomography; Tumors of the urinary system; Radionuclide study; radio-guided surgery; Nephrology; Carcinoma; Staging; Sentinel lymph node; Node; Urology; lymph node staging, sentinel node; Surgery; Grawitz tumor; Diagnosis; Draining; Kidney disease; Urinary system disease; Lymph node; Stage classification; single photon emission computed tomography; Malignant tumor; Single photon emission tomography; Guidance; renal cell carcinoma; Treatment; Kidney cancer; Feasibility; Cancer
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10444.x

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Sentinel node detection in renal cell carcinoma (RCC) is a completely new field. This method of nodal detection can be utilized as a starting point for adoptive immunotherapy, only previously described in colon cancer and in advanced urothelial cancer of the urinary bladder. The study adds a description of available methods and techniques for sentinel node detection in RCC. OBJECTIVE •  To evaluate the feasibility of performing sentinel node detection in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS •  An open series of 13 arbitrarily selected patients with T1b–T3b RCC scheduled for radical nephrectomy at a single Tertiary Academic Centre were examined with different modalities of sentinel node detection. •  Preoperative ultrasonography‐guided injection of radioactive isotope, lymphoscintigram and single photon emission computed tomography/computed tomography, followed by intraoperative gamma‐probe detection and Patent Blue detection, as well as postoperative scintigram of the main specimen were the planned interventions. •  These investigations were performed in conjunction with intended open radical nephrectomy. RESULTS •  In 10 of the 13 patients sentinel node detection was achieved with 32 sentinel nodes displayed. •  Radio‐guided surgery using an intraoperative gamma‐probe resulted in the highest realtive detection rate with detection of sentinel nodes in nine patients. •  In total, nine metastatic sentinel nodes were detected in three patients. •  One patient, preoperatively staged as N+, was restaged after sentinel node detection and histopathology as pN0. CONCLUSIONS •  Sentinel node detection in renal tumours is feasible although evaluation of different modes of detection needs further refinement and standardization. •  All nodes preoperatively detected by routine computed tomography as suspicious metastatic lesions were confirmed as sentinel nodes, including two nodes considered as metastatic by preoperative routine imaging but ultimately staged as non‐metastatic sentinel nodes.