Sentinel lymph node biopsy in renal malignancy: The past, present and future

Abstract

Sentinel lymph node biopsy (SLNB) is now an established technique in penile and pelvic cancers, resulting in a lower mortality and morbidity when compared with the traditional lymph node dissection. In renal cancer however, despite some early successes for the SLNB technique, paucity of data remains a problem, thus lymph node dissection and extended lymph node dissection remain the management of choice in clinically node positive patients, with surveillance of lymph nodes in those who are clinically node negative. SLNB is a rapidly evolving technique and the introduction of new techniques such as near infra-red fluorescence optical imaging agents and positron emission tomography/computed tomography scans, may improve sensitivity. Evidence in support of this has already been recorded in bladder and prostate cancer. Although the lack of large multi-centre studies and issues around false negativity currently prevent its widespread use, with evolving techniques improving accuracy and the support of large-scale studies, SLNB does have the potential to become an integral part of staging in renal malignancy.

The Current Role of Lymph Node Dissection in Nonmetastatic Localized Renal Cell Carcinoma

“…The detection rate of LNM with SNLB ranges between 61-82% [68][69][70], but these results are restricted by small sample sizes. SNLB has potential for improvement with modifications, such as PET/CT or near infra-red fluorescence optical imaging agents [71], but its therapeutic implication in high-risk patients is still unknown and requires standardization. Its use will remain experimental until larger prospective studies are conducted.…”

Technical advances in the surgical management of Wilms tumors in children

“…The concept of sentinel lymph nodes (SLN), seen as the first level of drainage, has been used in a few publications related to adult kidney cancer. 42,44 Bex and his colleagues were the first to use blue dye and intraoperative gamma probes in humans; their pilot involved intratumoral injection of a radiolabeled tracer to guide LN sampling in eight patients with clinically nonmetastatic RCC. 45 Surgery with sampling was performed the following day using a gamma probe and a portable mini gamma camera.…”