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Published on: October 20, 2010
Sentinel lymph node biopsy in upper tract urothelial cancers: an experience with intraoperative radiotracer injection
Leili Zarifmahmoudi1, Hamidreza Ghorbani2, Ramin Sadeghi1
1Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Background:
The feasibility of the sentinel node mapping in upper tract urothelial cancers (UTUC) was evaluated, using a radiotracer as the mapping material.
Material And Methods:
To identify the sentinel lymph nodes, 37 MBq of [99mTc] phytate was injected in five patients with the renal pelvis or ureter cancer, who were candidates for ureterectomy and lymphadenectomy. The radiotracer was injected in a peritumoral fashion following the surgical exposure of the tumour. The sentinel lymph nodes were detected using a handheld gamma probe.
Results:
By intraoperatively injecting the radiotracer immediately after surgical exposure of the tumour, at least one sentinel lymph node could be detected in each patient, and the detection rate was 100%. The location of sentinel nodes was in the paracaval, renal hill, retro-aortic, para-aortic, common iliac, and external iliac areas, which was dependent on the tumour location. No false-negative case was identified.
Conclusions:
Sentinel node mapping is feasible in UTUC. Injection technique (intra-vesical approach vs peri-tumoral injection after exposure of the tumour) and location of the tumour (proximal vs distal) may affect the technique's feasibility.
