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Sentinel lymph node biopsy in muscle-invasive bladder cancer: single-center experience

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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 muscle-invasive 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.

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Funding

This study was the result of a PhD thesis and was supported by vice chancellery of research of Mashhad University of Medical Sciences with the approval number of 940295.

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Authors and Affiliations

  1. Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

    Leili Zarifmahmoudi, Ramin Sadeghi & Kayvan Sadri

  2. Department of Urology, Mashhad University of Medical Sciences, Mashhad, Iran

    Hamidreza Ghorbani, Mahmoud Tavakkoli & Maliheh Keshvari

  3. Department of Community Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Maryam Salehi

Authors
  1. Leili Zarifmahmoudi
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  2. Hamidreza Ghorbani
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  3. Ramin Sadeghi
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  4. Kayvan Sadri
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  5. Mahmoud Tavakkoli
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  6. Maliheh Keshvari
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  7. Maryam Salehi
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Correspondence to Hamidreza Ghorbani.

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Zarifmahmoudi, L., Ghorbani, H., Sadeghi, R. et al. Sentinel lymph node biopsy in muscle-invasive bladder cancer: single-center experience. Ann Nucl Med 34, 718–724 (2020). https://doi.org/10.1007/s12149-020-01502-6

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  • DOI: https://doi.org/10.1007/s12149-020-01502-6

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