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Radio‐guided sentinel lymph node detection and lymph node mapping in invasive urinary bladder cancer: a prospective clinical study
Author(s) -
Aljabery Firas,
Shabo Ivan,
Olsson Hans,
Gimm Oliver,
Jahnson Staffan
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13700
Subject(s) - medicine , lymphovascular invasion , lymph node , bladder cancer , lymph , sentinel lymph node , gamma probe , urology , dissection (medical) , sentinel node , cystectomy , stage (stratigraphy) , biopsy , urinary bladder , lymphatic system , radiology , cancer , nuclear medicine , metastasis , pathology , breast cancer , paleontology , biology
Objectives To investigate the possibility of detecting sentinel lymph nodes ( SN s) in patients with urinary bladder cancer ( BC a) intra‐operatively and whether the histopathological status of the identified SN s reflected that of the lymphatic field. Patients and Methods We studied 103 patients with BC a pathological stage T1–T4 who were treated with cystectomy and pelvic lymph node ( LN ) dissection during 2005–2011 at the Department of Urology, Linköping University Hospital. Radioactive tracer Nanocoll 70 MBq and blue dye were injected into the bladder wall around the primary tumour before surgery. SN s were detected ex vivo during the operation with a handheld Geiger probe (Gamma Detection System; Neoprobe Corp., Dublin, OH, USA). All LN s were formalin‐fixed, sectioned three times, mounted on slides and stained with haematoxylin and eosin. An experienced uropathologist evaluated the slides. Results The mean age of the patients was 69 years, and 80 (77%) were male. Pathological staging was T1–12 (12%), T2–20 (19%), T3–48 (47%) and T4–23 (22%). A mean (range) number of 31 (7–68) nodes per patient were examined, totalling 3 253 nodes. LN metastases were found in 41 patients (40%). SN s were detected in 83 of the 103 patients (80%). Sensitivity and specificity for detecting metastatic disease by SN biopsy ( SNB ) varied between LN stations, with average values of 67% and 90%, respectively. LN metastatic density ( LNMD ) had a significant prognostic impact; a value of ≥8% was significantly related to shorter survival. Lymphovascular invasion ( LVI ) occurred in 65% of patients ( n = 67) and was significantly associated with shorter cancer‐specific survival ( P < 0.001). Conclusion We conclude that SNB is not a reliable technique for peri‐operative localization of LN metastases during cystectomy for BC a; however, LNMD has a significant prognostic value in BC a and may be useful in the clinical context and in BC a oncological and surgical research. LVI was also found to be a prognostic factor.