Feasibility of sentinel lymph node mapping in renal cell carcinoma using intraoperative radiotracer injection

Document Type: Original Article

Authors

1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: The applicability of sentinel lymph node biopsy for early detection of metastasis in patients with renal cell carcinoma (RCC) is still in the validation phase and under investigation, which might be due to the unpredictability of the lymphatic pattern in RCC. In this study, we aimed to evaluate the feasibility and accuracy of sentinel node biopsy in patients with renal masses.
Methods: In this prospective study, twenty-one candidates for open radical nephrectomy with T1-T3 renal tumors, were included consecutively. Sentinel nodes were sought using a hand-held gamma probe following the injection of radiotracer. The validity of sentinel node biopsy procedure as our index test was compared with lymphadenectomy as the standard method for staging and detecting the regional lymph nodes metastasis.
Results: At least one sentinel lymph node was detected in thirteen of the patients using a hand-held gamma probe, and the detection rate was 61%. There was no patient with positive pathological involvement of the regional lymph nodes despite the negative involvement of the sentinel lymph node; so, the false-negative rate was 0%.
Conclusion: Although sentinel lymph node biopsy was feasible in patients with RCC, sentinel node detection failure was high in our study. More prospective studies with a larger sample size are needed for standardization of the radiotracer injecting aspects and mapping method to increase the detection rate and to evaluate the false negative rate more accurately.

Keywords

Main Subjects


  1. Capitanio U, Becker F, Blute ML, Mulders P, Patard JJ, Russo P, Studer UE, Van Poppel H. Lymph node dissection in renal cell carcinoma. Eur Urol. 2011;60(6):1212-20.
  2. Stabile A, Muttin F, Zamboni S, Moschini M, Gandaglia G, Fossati N, Dell'Oglio P, Capitanio U, Cucchiara V, Mazzone E, Bravi CA, Mirone V, Montorsi F, Briganti A. Therapeutic approaches for lymph node involvement in prostate, bladder and kidney cancer. Expert Rev Anticancer Ther. 2019 Sep;19(9):739-755.
  3. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer 1977;39(2):456-66.
  4. Sadeghi R, Gholami H, Zakavi SR, Kakhki VR, Tabasi KT, Horenblas S. Accuracy of sentinel lymph node biopsy for inguinal lymph node staging of penile squamous cell carcinoma: systematic review and meta-analysis of the literature. J Urol. 2012;187(1):25-31.
  5. Javan H, Gholami H, Assadi M, Pakdel AF, Sadeghi R, Keshtgar M. The accuracy of sentinel node biopsy in breast cancer patients with the history of previous surgical biopsy of the primary lesion: systematic review and meta-analysis of the literature. Eur J Surg Oncol. 2012;38(2):95-109.
  6. Ansari M, Rad MA, Hassanzadeh M, Gholami H, Yousefi Z, Dabbagh VR, Sadeghi R. Sentinel node biopsy in endometrial cancer: systematic review and meta-analysis of the literature. Eur J Gynaecol Oncol. 2013;34(5):387-401.
  7. Farazestanian M, Yousefi Z, Zarifmahmoudi L, Mofrad MH, Kadkhodayan S, Sadeghi R. Concordance between intracervical and fundal injections for sentinel node mapping in patients with endometrial cancer?: a study using intracervical radiotracer and fundal blue dye injections. Clin Nucl Med. 2019;44(3):e123-e27.
  8. Hassanzadeh M, Farahabadi EH, Yousefi Z, Kadkhodayan S, Zarifmahmoudi L, Sadeghi R. Lymphatic mapping and sentinel node biopsy in ovarian tumors: a study using intra-operative Tc-99m-Phytate and lymphoscintigraphy imaging. J Ovarian Res. 2016;9(1):55.
  9. Sadeghi R, Asadi M, Treglia G, Zakavi SR, Fattahi A, Krag DN. Axillary concordance between superficial and deep sentinel node mapping material injections in breast cancer patients: systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2014;144(2):213-22.
  10. Sadeghi R, Tabasi K, Bazaz S, Kakhki V, Massoom A, Gholami H, Zakavi S. Sentinel node mapping in the prostate cancer: meta-analysis. Nuklearmedizin. 2011;50(3):107-15.
  11. Bersanelli M, Buti S, Santoni M, Ziglioli F, Maestroni U. Pathological nodal staging score for renal cell carcinoma: how to build reliable therapeutic choices basing on assumptions. Ann Transl Med. 2019;7(Suppl 1):S54.
  12. Bhindi B, Wallis CJ, Boorjian SA, Thompson RH, Farrell A, Kim SP, Karam JA, Capitanio U, Golijanin D, Leibovich BC. The role of lymph node dissection in the management of renal cell carcinoma: a systematic review and meta‚Äźanalysis. BJU international. 2018;121(5):684-98.
  13. Kim BS, Yoo ES, Kim TH, Kwon TG. Chylous ascites as a complication of laparoscopic nephrectomy. J Urol. 2010;184(2):570-4.
  14. Capitanio U, Leibovich BC. The rationale and the role of lymph node dissection in renal cell carcinoma. World J Urol. 2017 Apr;35(4):497-506.
  15. Zarifmahmoudi L, Sadeghi R. Re: radio-guided lymph node mapping in bladder cancer Using SPECT/CT and intraoperative γ-probe methods. Clin Nucl Med. 2017 Apr;42(4):327.
  16. Fattahi AS, Tavassoli A, Rohbakhshfar O, Sadeghi R, Abdollahi A, Forghani MN. Can methylene blue dye be used as an alternative to patent blue dye to find the sentinel lymph node in breast cancer surgery? J Res Med Sci. 2014;19(10):918-22.
  17. Sadeghi R. Sentinel node mapping diagnostic studies warrant a unique reporting criteria: comment on Xiong et al. systematic review. Eur J Surg Oncol. 2014;40(8):1025-6.
  18. Sherif AM, Eriksson E, Thorn M, Vasko J, Riklund K, Ohberg L, Ljungberg BJ. Sentinel node detection in renal cell carcinoma. A feasibility study for detection of tumour-draining lymph nodes. BJU Int. 2012;109(8):1134-9.
  19. Kuusk T, Donswijk ML, Valdes Olmos RA, De Bruijn RE, Brouwer OR, Hendricksen K, Horenblas S, Jozwiak K, Prevoo W, Van Der Poel HG, Van Rhijn BWG, Wit EM, Bex A. An analysis of SPECT/CT non-visualization of sentinel lymph nodes in renal tumors. EJNMMI Res. 2018;8(1):105.
  20. Hulten L, Rosencrantz M, Seeman T, Wahlqvist L, Ahren C. Occurrence and localization of lymph node metastases in renal carcinoma. A lymphographic and histopathological investigation in connection with nephrectomy. Scand J Urol Nephrol. 1969;3(2):129-33.
  21. Saitoh H, Nakayama M, Nakamura K, Satoh T. Distant metastasis of renal adenocarcinoma in nephrectomized cases. J Urol. 1982;127(6):1092-5.
  22. Mahon TG, Libshitz HI. Mediastinal metastases of infradiaphragmatic malignancies. Eur J Radiol. 1992;15(2):130-4.
  23. Karmali RJ, Suami H, Wood CG, Karam JA. Lymphatic drainage in renal cell carcinoma: back to the basics. BJU Int. 2014;114(6):806-17.
  24. Moschini M, Dell'Oglio P, Larcher A, Capitanio U. Lymph node dissection for renal cell carcinoma: what are we missing? Curr Opin Urol. 2016;26(5):424-31.
  25. Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, Giles RH, Hofmann F, Hora M, Kuczyk MA, Kuusk T, Lam TB, Marconi L, Merseburger AS, Powles T, Staehler M, Tahbaz R, Volpe A, Bex A. European association of urology guidelines on renal cell carcinoma: The 2019 update. ur Urol. 2019 May;75(5):799-810.
  26. Motzer RJ, Jonasch E, Michaelson MD, Nandagopal L, Gore JL, George S, Alva A, Haas N, Harrison MR, Plimack ER. NCCN Guidelines Insights: Kidney Cancer, Version 2.2020. J Natl Compr Canc Netw. . 2019 Nov 1;17(11):1278-1285.
  27. Assadi M, Yarani M, Zakavi SR, Jangjoo A, Memar B, Treglia G, Aliakbarian M, Mehrabibahar M, Sadeghi R. Sentinel node mapping in papillary thyroid carcinoma using combined radiotracer and blue dye methods. Endokrynol Pol. 2014;65(4):281-6.
  28. Motamedolshariati M, Rezaei E, Beiraghi-Toosi A, Jahani A, Tayyebi Meibodi N, Fattahi A. Sentinel node mapping in Marjolin’s ulcers: is it feasible. Wounds. 2015;27(3):54-62.