Sentinel lymph node biopsy in muscle-invasive bladder cancer: single-center experience
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ORIGINAL ARTICLE
Sentinel lymph node biopsy in muscle‑invasive bladder cancer: single‑center experience Leili Zarifmahmoudi1 · Hamidreza Ghorbani2 · Ramin Sadeghi1 · Kayvan Sadri1 · Mahmoud Tavakkoli2 · Maliheh Keshvari2 · Maryam Salehi3 Received: 11 June 2020 / Accepted: 28 June 2020 © The Japanese Society of Nuclear Medicine 2020
Abstract Objective In this study, the validity of sentinel node biopsy procedure as our index test was assessed and compared with bilateral pelvic lymphadenectomy for staging and detecting the regional lymph nodes metastasis in patients with muscleinvasive bladder cancer (MIBC). Methods Consecutive series of cases with T1–T4 urothelial MIBC were included. Following the injection of radiotracer, sentinel nodes were sought using a handheld gamma probe and all hot nodes were harvested. Bilateral pelvic lymphadenectomy was done for all patients following sentinel node biopsy. The tumor specimen, sentinel nodes, and excised lymph nodes were evaluated histopathologically. Same as the other midline tumors, detection rate and false negative rates were calculated using patient basis and side basis methods. Results By evaluating each patient as a unit of analysis, sentinel nodes were detected in 35 of 41 patients (85%), 13/16 (81%) of the neoadjuvant chemotherapy (NAC) and 22/25 (88%) of the no-neoadjuvant chemotherapy (No-NAC) participants. The false negative rate was 3/7 (42%): 1/3 (33%) for NAC, and 2/4 (50%) for No-NAC patients. By evaluating each hemipelvis as a unit of analysis, sentinel nodes were detected in 53 of 82 hemipelves (65%), 19/32 (66%) of the NAC, and 34/50 (68%) of the No-NAC hemipelves. No false-negative result was found by assessing each hemipelvis as a unit of analysis. Conclusions Sentinel node biopsy is a feasible method for lymph node staging in MIBC, including patients with a history of NAC. To optimize the sensitivity, the decision regarding the lymphadenectomy is best to be based on the pathological status of sentinel node harvested from each hemipelvis separately as the unilateral finding of a sentinel node, does not rule out the possibility of metastatic involvement of contralateral pelvic lymph nodes. Keywords Bladder · Cancer · Nuclear medicine · Sentinel lymph node · Lymphoscintigraphy
Introduction Bladder cancer (BC) is the 7th common malignancy in male; however, it is ranked 11th when both genders are considered. The incidence and mortality rate of the BC varies over different countries due to various risk factors, detection and diagnostic strategies, and treatment approaches in each * Hamidreza Ghorbani [email protected] 1
Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
2
Department of Urology, Mashhad University of Medical Sciences, Mashhad, Iran
3
Department of Community Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
country. Although the global incidence of bladder cancer is increasing, its mortality has been reduced [1]. Radical cystectomy (RC) with bilateral pelvic lymph no
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