Sentinel lymph node biopsy in pediatric Wilms tumor

Area of Science:

• Pediatric Oncology
• Surgical Oncology
• Diagnostic Accuracy

Background:

• Sentinel lymph node biopsy (SLNB) is established for adult solid tumors but underutilized in pediatric cases.
• Experience with SLNB in pediatric solid renal tumors remains limited, necessitating further investigation.

Purpose of the Study:

• To evaluate the safety and efficacy of intraoperative sentinel lymph node detection in pediatric solid renal tumors.
• To assess the accuracy of SLNB in staging Wilms tumor and identify potential improvements in technique.

Main Methods:

• A cohort of 20 pediatric patients with primary Wilms tumor underwent SLNB during radical nephrectomy.
• Radiotracer was injected after ligation of renal vessels and ureter; sentinel nodes were identified by radioactivity and sampled.
• Histopathological analysis of sentinel and other lymph nodes determined tumor involvement.

Main Results:

• A single sentinel lymph node (SLN) was identified in 16 patients, with multiple SLNs in 4.
• The interaortocaval space was the most common SLN location.
• 15% of SLNs showed tumor involvement; no false negatives were observed, indicating high diagnostic accuracy.

Conclusions:

• Intraoperative SLNB is a safe and feasible method for improving staging accuracy in pediatric Wilms tumor.
• Ligating the renal artery and vein before radiotracer injection is recommended to reduce background interference.
• SLNB can enhance precision in managing pediatric renal tumors.