Sentinel Lymph Node Techniques in Urologic Oncology: Current Knowledge and Application

Małkiewicz, Bartosz; Kiełb, Paweł; Kobylański, Maximilian; Karwacki, Jakub; Poterek, Adrian; Krajewski, Wojciech; Zdrojowy, Romuald; Szydełko, Tomasz

doi:10.3390/cancers15092495

Cited by 6 publications

(3 citation statements)

References 159 publications

(168 reference statements)

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“…The ongoing debate in the PCa field regarding ipsi- and contralateral LNI, coupled with emerging studies on sentinel LN mapping, particularly heightens the relevance of our investigation [ 15 , 16 , 35 , 36 , 37 ]. Bilateral pelvic lymphadenectomy performed during RP remains the gold standard for nodal staging [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Lymphovascular Invasion with Lymph Node Metastases in Prostate Cancer—Lateralization Concept

Karwacki,

Gurwin,

Jaworski

et al. 2024

Cancers

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Background. Lymphovascular invasion (LVI) is a vital but often overlooked prognostic factor in prostate cancer. As debates on lymphadenectomy’s overtreatment emerge, understanding LVI laterality gains importance. This study pioneers the investigation into PCa, aiming to uncover patterns that could influence tailored surgical strategies in the future. Methods. Data from 96 patients with both LVI and lymph node invasion (LNI) were retrospectively analyzed. All participants underwent radical prostatectomy (RP) with modified-extended pelvic lymph node dissection (mePLND). All specimens underwent histopathological examination. The assessment of LVI was conducted separately for the right and left lobes of the prostate. Associations within subgroups were assessed using U-Mann–Whitney and Kruskal–Wallis tests, as well as Kendall’s tau-b coefficient, yielding p-values and odds ratios (ORs). Results. Out of the 96 patients, 61 (63.5%) exhibited exclusive left-sided lymphovascular invasion (LVI), 24 (25.0%) had exclusive right-sided LVI, and 11 (11.5%) showed bilateral LVI. Regarding nodal involvement, 23 patients (24.0%) had LNI solely on the left, 25 (26.0%) exclusively on the right, and 48 (50.0%) on both sides. A significant correlation was observed between lateralized LVI and lateralized LNI (p < 0.001), particularly in patients with right-sided LVI only. LN-positive patients with left-sided LVI tended to have higher pT stages (p = 0.047) and increased odds ratios (OR) of bilateral LNI (OR = 2.795; 95% confidence interval [CI]: 1.231–6.348) compared to those with exclusive right-sided LVI (OR = 0.692; 95% CI: 0.525–0.913). Conclusions. Unilateral LVI correlates with ipsilateral LNI in PCa patients with positive LNs, notably in cases of exclusively right-sided LVI. Left-sided LVI associates with higher pT stages and a higher percentage of bilateral LNI cases.

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Section: Discussionmentioning

confidence: 99%

Association of Lymphovascular Invasion with Lymph Node Metastases in Prostate Cancer—Lateralization Concept

Karwacki,

Gurwin,

Jaworski

et al. 2024

Cancers

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“…The above-mentioned findings indicate that SLN detection in tumors of the urinary system, such as bladder cancer and prostate cancer, still lacks reliable theoretical basis ( 34 ). Transurethral intravesical injection of ICG not only carries the risk of urethral injury and infection but also poses challenges in controlling the injection site, dosage, and depth, leading to potential issues such as ICG leakage and intraoperative fluorescence contamination.…”

Section: Discussionmentioning

confidence: 99%

A preliminary investigation of precise visualization, localization, and resection of pelvic lymph nodes in bladder cancer by using indocyanine green fluorescence-guided approach through intracutaneous dye injection into the lower limbs and perineum

Zhang,

Guo,

Zhang

et al. 2024

Front. Oncol.

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ObjectiveThis study aimed to investigate the feasibility and effectiveness of using indocyanine green (ICG) injected intracutaneously through the lower limbs and perineum for visualized tracking, localization, and qualitative assessment of pelvic lymph nodes (LNs) in bladder cancer to achieve their accurate resection.MethodsFirst, ICG was injected into the LN metastasis model mice lower limbs, and real-time and dynamic in vivo and ex vivo imaging was conducted by using a near-infrared fluorescence imaging system. Additionally, 26 patients with bladder cancer were enrolled and divided into intracutaneous group and transurethral group. A near-infrared fluorescence imaging device with internal and external imaging probes was used to perform real-time tracking, localization, and resection of the pelvic LNs.ResultsThe mice normal LNs and the metastatic LNs exhibited fluorescence. The metastatic LNs showed a significantly higher signal-to-background ratio than the normal LNs (3.9 ± 0.2 vs. 2.0 ± 0.1, p < 0.05). In the intracutaneous group, the accuracy rate of fluorescent-labeled LNs was 97.6%, with an average of 11.3 ± 2.4 LNs resected per patient. Six positive LNs were detected in three patients (18.8%). In the transurethral group, the accuracy rate of fluorescent-labeled LNs was 84.4%, with an average of 8.6 ± 2.3 LNs resected per patient. Two positive LNs were detected in one patient (12.5%).ConclusionFollowing the intracutaneous injection of ICG into the lower limbs and perineum, the dye accumulates in pelvic LNs through lymphatic reflux. By using near-infrared fluorescence laparoscopic fusion imaging, physicians can perform real-time tracking, localization, and precise resection of pelvic LNs.

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“…The sentinel lymph node technique (SLN) may improve the detection of metastatic disease while limiting the possible complications resulting from extended lymphadenectomy. Despite promising results, its use remains controversial, and it is not recommended as a standard procedure [ 220 , 221 ]. To improve the intraoperative detection of sentinel nodes or other potentially metastatic lymph nodes, new techniques using gamma probes or cameras with fluorescence detection have been used.…”

Section: New Perspectives For Biomarkers In Pcamentioning

confidence: 99%

Novel Histopathological Biomarkers in Prostate Cancer: Implications and Perspectives

et al. 2023

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Prostate cancer (PCa) is the second most frequently diagnosed cancer in men. Despite the significant progress in cancer diagnosis and treatment over the last few years, the approach to disease detection and therapy still does not include histopathological biomarkers. The dissemination of PCa is strictly related to the creation of a premetastatic niche, which can be detected by altered levels of specific biomarkers. To date, the risk factors for biochemical recurrence include lymph node status, prostate-specific antigen (PSA), PSA density (PSAD), body mass index (BMI), pathological Gleason score, seminal vesicle invasion, extraprostatic extension, and intraductal carcinoma. In the future, biomarkers might represent another prognostic factor, as discussed in many studies. In this review, we focus on histopathological biomarkers (particularly CD169 macrophages, neuropilin-1, cofilin-1, interleukin-17, signal transducer and activator of transcription protein 3 (STAT3), LIM domain kinase 1 (LIMK1), CD15, AMACR, prostate-specific membrane antigen (PSMA), Appl1, Sortilin, Syndecan-1, and p63) and their potential application in decision making regarding the prognosis and treatment of PCa patients. We refer to studies that found a correlation between the levels of biomarkers and tumor characteristics as well as clinical outcomes. We also hypothesize about the potential use of histopathological markers as a target for novel immunotherapeutic drugs or targeted radionuclide therapy, which may be used as adjuvant therapy in the future.

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Sentinel Lymph Node Techniques in Urologic Oncology: Current Knowledge and Application

Cited by 6 publications

References 159 publications

Association of Lymphovascular Invasion with Lymph Node Metastases in Prostate Cancer—Lateralization Concept

Association of Lymphovascular Invasion with Lymph Node Metastases in Prostate Cancer—Lateralization Concept

A preliminary investigation of precise visualization, localization, and resection of pelvic lymph nodes in bladder cancer by using indocyanine green fluorescence-guided approach through intracutaneous dye injection into the lower limbs and perineum

Novel Histopathological Biomarkers in Prostate Cancer: Implications and Perspectives

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