Molecular Detection Of Lymph Node Involvement In Genitourinary Cancer

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 13 Apr 2008 - 0:00 PDT

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UroToday.com - Dr. Michael Jewett (Toronto) presented the SIU lecture on detection and mapping regional lymph nodes (LN) in genitourinary cancer. He addressed the importance of LN in staging and therapy of GU cancers. Staging is prognostic and sets the scenario for adjuvant therapy. Lymphadenectomy (LA) is therapeutic and should be performed. The first lymphangiogram was performed in Britain in 1956 and set the stage for imaging. CT scanning if less than 8mm in the round dimension or 10mm on short axis if oval are historically considered normal. However, he challenged the 8-10mm size threshold as normal, and that macrometastases can exist in this size range. Dr. Jewett felt that CT or MRI are inadequate for staging and should not replace surgical staging.

The sentinel LN can be targeted using molecular probes and has been utilized in other cancers. Quantum dots with fluorescence holds promise and has been applied to melanoma. In urology, using these techniques is less developed. Also, lymph nodes can connect to micro-vessels and these vessels can serve as a mechanism for further dissemination. Probes can be injected directly into the primary tumor and color or radiation can then be identified and surgically removed. Often, the sentinel LN can serve as an indicator for involvement of more distant nodes. A better understanding of signal noise from normal nodes needs further investigation, he said. Lymphotrophic nanoparticle enhanced MRI holds promise, but the radiologist must be dedicated to the procedure to obtain reproducible results. Dr. Jewett reviewed the work of Dr. Cabanas in using the sentinel LN in penile cancer as he reported in 1977. This has evolved into scintography that is used by some in present day. The sentinel LN concept has evolved into templates for LA in testicular cancer and the extended LA in bladder and prostate cancers.

He concluded that surgical mapping remains the standard, although newer probes may eventually have a place in clinical management.

Presented by: Michael Jewett, MD, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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