Lymphatic mapping and detection of sentinel nodes in patients with bladder cancer.

PURPOSE We examined the possibility for detecting sentinel nodes in patients with bladder cancer and whether the histopathological status of identified sentinel nodes reflected that of the lymphatic field. MATERIALS AND METHODS A total of 13 patients with bladder cancer who met the criteria qualifying them for radical cystectomy had intravesical injections of radioactive tracer and blue dye marker around the tumor followed by lymphoscintigraphy to visualize lymphatic drainage and detect sentinel nodes. Sentinel nodes were identified preoperatively by the blue color and increased radioactivity and were compared histopathologically with other routinely excised lymph nodes. RESULTS Sentinel nodes were detected in 85% (11 of 13) of patients. There were 4 patients who had sentinel nodes containing tumor cells, and each metastasis was only seen in the detected sentinel node. There were no false-negative sentinel nodes. Of the metastatic sentinel nodes 3 were located outside the normally excised lymph nodes of the obturator fossa. CONCLUSIONS Sentinel nodes can be detected in patients with bladder cancer. The histopathological status of the identified sentinel nodes was diagnostic for all other excised lymph nodes. Sentinel nodes often seem to be located outside the obturator lymphatic field, which is normally examined during preoperative staging of bladder cancer.

[1]  F. Burkhard,et al.  Reliability of preoperative values to determine the need for lymphadenectomy in patients with prostate cancer and meticulous lymph node dissection. , 2002, European urology.

[2]  K. Steven,et al.  Radical cystectomy: extending the limits of pelvic lymph node dissection improves survival for patients with bladder cancer confined to the bladder wall. , 1998, The Journal of urology.

[3]  F. Wawroschek,et al.  Radioisotope guided pelvic lymph node dissection for prostate cancer. , 2001, The Journal of urology.

[4]  P. Clark Radical cystectomy for carcinoma of the bladder. , 1978, British journal of urology.

[5]  M. Soloway,et al.  Cis‐diamminedichloroplatinum (II) in locally advanced and metastatic urothelial cancer , 1981, Cancer.

[6]  L. Mazzucchelli,et al.  Adjuvant cisplatin chemotherapy following cystectomy for bladder cancer: results of a prospective randomized trial. , 1994, The Journal of urology.

[7]  R. Cote,et al.  Molecular determinants of outcome in bladder cancer. , 1999, The cancer journal from Scientific American.

[8]  R. Babaian,et al.  Incidence, extent and location of unsuspected pelvic lymph node metastasis in patients undergoing radical cystectomy for bladder cancer. , 1987, The Journal of urology.

[9]  R. Babaian,et al.  Adjuvant cyclophosphamide, doxorubicin, and cisplatin chemotherapy for bladder cancer: an update. , 1988, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  M. Thörn Lymphatic mapping and sentinel node biopsy: is the method applicable to patients with colorectal and gastric cancer? , 2000, The European journal of surgery = Acta chirurgica.

[11]  D. Krag,et al.  Gamma-probe guided localization of lymph nodes. , 1993, Surgical oncology.

[12]  W. See,et al.  Staging of advanced bladder cancer. Current concepts and pitfalls. , 1992, The Urologic clinics of North America.

[13]  P. Ell,et al.  Clinical role of sentinel-lymph-node biopsy in breast cancer. , 2002, The Lancet. Oncology.

[14]  M. Resnick,et al.  Limitations of computerized tomography in staging invasive bladder cancer before radical cystectomy. , 2000, The Journal of urology.

[15]  Donald L. Morton,et al.  Lymphatic Mapping and Sentinel Lymphadenectomy for Breast Cancer , 1994, Annals of surgery.

[16]  C. Cordon-Cardo,et al.  Genetic and Molecular Markers of Urothelial Premalignancy and Malignancy , 2000, Scandinavian journal of urology and nephrology. Supplementum.

[17]  J. Thüroff,et al.  Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis , 2000, BJU international.

[18]  F. Wawroschek,et al.  The influence of serial sections, immunohistochemistry, and extension of pelvic lymph node dissection on the lymph node status in clinically localized prostate cancer. , 2003, European urology.

[19]  P. Bassi,et al.  Prognostic factors of outcome after radical cystectomy for bladder cancer: a retrospective study of a homogeneous patient cohort. , 1999, The Journal of urology.

[20]  S. Groshen,et al.  The rationale for en bloc pelvic lymph node dissection for bladder cancer patients with nodal metastases: long-term results. , 1993, The Journal of urology.

[21]  J. Portillo,et al.  Neoadjuvant cisplatin chemotherapy before radical cystectomy in invasive transitional cell carcinoma of the bladder: a prospective randomized phase III study. , 1995, The Journal of urology.

[22]  M. Ross,et al.  Recent advances in the care of the patient with malignant melanoma. , 1997, Annals of surgery.

[23]  K. Matsumoto,et al.  Relationship between p53 gene mutation and protein expression: clinical significance in transitional cell carcinoma of the bladder. , 2000, International journal of oncology.

[24]  R. Wahlqvist,et al.  Five-year followup of a prospective trial of radical cystectomy and neoadjuvant chemotherapy: Nordic Cystectomy Trial I. The Nordic Cooperative Bladder Cancer Study Group. , 1996, The Journal of urology.

[25]  H. Müller-Gärtner,et al.  Staging of Pelvic Lymph Nodes in Neoplasms of the Bladder and Prostate by Positron Emission Tomography with 2-[18F]-2-Deoxy-D-Glucose , 1999, European Urology.

[26]  R. Cabanas,et al.  An approach for the treatment of penile carcinoma , 1977, Cancer.

[27]  D. de Jong,et al.  Detection of occult metastasis in squamous cell carcinoma of the penis using a dynamic sentinel node procedure. , 2000, The Journal of urology.

[28]  M. Gomha,et al.  A predictive model of survival after radical cystectomy for carcinoma of the bladder , 2000, BJU international.

[29]  S. Groshen,et al.  p53 nuclear protein accumulation correlates with mutations in the p53 gene, tumor grade, and stage in bladder cancer. , 1993, The American journal of pathology.

[30]  M. Deavers,et al.  Lymphatic mapping and sentinel node identification in patients with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[31]  D. Weaver,et al.  Gamma-probe-guided lymph node localization in malignant melanoma. , 1993, Surgical oncology.

[32]  A E Giuliano,et al.  Sentinel-lymph-node biopsy for breast cancer--not yet the standard of care. , 1998, The New England journal of medicine.

[33]  D L Morton,et al.  Technical details of intraoperative lymphatic mapping for early stage melanoma. , 1992, Archives of surgery.