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Sentinel node biopsy and lymphatic mapping in penile and prostate cancer

Wächterlymphknotenresektion und Lymphknotenmapping bei Penis- und Prostatakarzinom

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Abstract

Background

Nodal metastases are linked to poor outcome in men with penile or prostate cancer. Early detection and resection are important for staging and for the prognosis. However, lymphadenectomy is associated with morbidity and may miss metastases when performed solely on the basis of anatomical templates.

Methods

In this article we describe the technique and benefits of sentinel node biopsy (SNB) and provide a review of the literature.

Results

Dynamic sentinel node techniques using both radioactive and optical (hybrid) tracers have been proven effective in penile cancer. For prostate cancer, SNB added to extended nodal dissection may further tailor dissection to the highly variable lymphatic drainage patterns in the pelvis. The sensitivity of SNB was found to be superior to conventional imaging methods; however, false-negative SNB procedures can occur and a complementary extensive lymphadenectomy is required to remove additional positive nodes that were not detected in the SNB template.

Conclusion

SNB is a standard method for early detection of nodal metastases in penile cancer and provides superior diagnostic accuracy to conventional imaging modalities in prostate cancer.

Zusammenfassung

Hintergrund

Eine lymphogene Metastasierung stellt einen ungünstigen prognostischen Faktor beim Penis- und Prostatakarzinom dar. Daher ist die frühe Erkennung und Resektion nicht nur zum korrekten Staging notwendig, sondern könnte auch für die Patienten von prognostischer Bedeutung sein. Die Lymphadenektomie ist jedoch mit einer gewissen Morbidität vergesellschaftet und birgt auch das Risiko, dass Lymphknotenmetastasen übersehen werden, vor allem, wenn sie sich nur an anatomischen Template-Feldern orientiert.

Methodik

Es erfolgt die Beschreibung der Technik und der Vorteile der Wächterlymphknotenresektion („sentinel node biopsy“, SNB) sowie eine Literaturübersicht.

Ergebnisse

Die Technik der dynamischen SNB, die radioaktive oder optische Tracer verwendet, ist beim Peniskarzinom etabliert. Beim Prostatakarzinom und dem hochgradig variablen Lymphabfluss im kleinen Becken könnte die SNB in Kombination mit einer ausgedehnten pelvinen Lymphknotendissektion von zusätzlichem Nutzen sein. Die Sensitivität der SNB ist der konventionellen Bildgebung überlegen, wobei jedoch auch hier falsch-negative Ergebnisse beobachtet werden, sodass bei diesen Patienten noch eine ergänzende ausgedehnte pelvine Lymphknotendissektion benötigt wird.

Schlussfolgerung

Die SNB ist eine Standardmethode zum frühen Erkennen von Lymphknotenmetastasen beim Peniskarzinom und ermöglicht eine erhöhte diagnostische Sicherheit im Vergleich zur konventionellen Bildgebung beim Prostatakarzinom.

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Authors and Affiliations

  1. Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands

    H. G. van der Poel, N. Grivas, G. KleinJan & S. Horenblas

  2. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    P. Meershoek & F. W. B. van Leeuwen

Authors
  1. H. G. van der Poel
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  2. P. Meershoek
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  3. N. Grivas
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  4. G. KleinJan
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  5. F. W. B. van Leeuwen
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  6. S. Horenblas
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Correspondence to H. G. van der Poel.

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Conflict of interest

H. G. van der Poel, P. Meershoek, N. Grivas,G. KleinJan, F. W.B. van Leeuwen and S. Horenblas declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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van der Poel, H.G., Meershoek, P., Grivas, N. et al. Sentinel node biopsy and lymphatic mapping in penile and prostate cancer. Urologe 56, 13–17 (2017). https://doi.org/10.1007/s00120-016-0270-7

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