Sentinel lymph node staging in urological cancer surgery: advances in imaging, intra-operative detection and...

To review the clinical utility, outcome and possible future applications of sentinel lymph node biopsy (SLNB) in penile cancer (PeC), bladder cancer (BCa), prostate cancer (PCa), testicular cancer (TCa) and renal cell carcinoma (RCC), focusing in particular on current SLNB standards and exploring advancements in imaging agents, intra-operative detection, surgical navigation, and the potential application of SLNB in translational and clinical research.

A literature search was conducted in PubMed and EMBASE for studies published between 2000 and 2024, providing a narrative review of SLNB in oncological urology.

In PeC, SLNB offers a lower adverse event rate compared to inguinal lymph node (LN) dissection, while maintaining high detection rates and acceptable sensitivity (92%-96%) for identifying inguinal LN metastases. Similarly, in PCa, SLNB achieves a sensitivity of 95%, potentially reinforcing its role in nodal staging and guiding personalised treatment strategies. For RCC, BCa and TCa, SLNB is currently under investigation in trials. In RCC, detection rates seem acceptable; however, in BCa and TCa, detection rates and false-negative rates vary, limiting its clinical usefulness. Contemporary approaches utilise various radiotracers, (fluorescent) dyes, and hybrid tracers for SLNB. Ongoing research refines tumour-targeted LN detection, including prostate-specific membrane antigen targeting in PCa, potential c-MET targeting in PeC, and ⁸⁹Zr-girentuximab in RCC.

The use of SLNB has transformed nodal staging in PeC, influencing treatment decisions and reducing morbidity in patients undergoing surgery. In other urological malignancies, it has not yet established itself as a standard tool for nodal staging. Its impact on survival, quality of life, and translational research remains to be determined.