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Studies have shown that mixed indocyanine green (ICG)-99mTc-nanocolloid tracer improves sentinel lymph node (SN) recognition compared to traditional dynamic sentinel lymph node biopsy (
DSNB).
Recently, researchers from Sweden published an article in Eur Urol Oncol investigating mixed tracer-guided SN recognition in a polycentric setting and identifying false negatives (FN) and complication rates
.
Between February 2016 and December 2017, researchers prospectively included a total of 130 penile cancer patients
scheduled for DSNB at two national referral centers in Sweden.
They used an ICG-99mTc-nanocolloidal hybrid tracer
in a standard DSNB protocol.
During surgery, SNs
are identified using radioguidance, fluorescence imaging, and blue staining.
During a median follow-up of 34 months, the number of SNs identified by each tracer was recorded, as well as the rate of
complications and lymph node recurrence.
The difference
in proportions between groups was compared using χ2 and McNemar's test.
Overall, 453 SNs
were identified preoperatively by single-photon emission computed tomography/computed tomography.
Of the 425 SNs resected, 414 (97%), 363 (85%) and 349 (82%)
were identified by radioguided, fluorescence, and blue staining, respectively.
Fluorescence imaging assisted in the detection of 6 SNs that were negative using other tracers, 2 of which were from the same patient and contained metastases
.
Histopathology found 33 metastatic SNs (15%)
in 20/130 patients.
The FN rate per groin was 12% (95% confidence interval 8-16%)
.
Preoperative and intraoperative outcomes
In summary, the recognition of SNs in penile cancer patients mainly relies on radiation guidance, while the optical SN recognition effect of fluorescence (ICG) and blue dyeing is equivalent
.
However, the value of fluorescence imaging needs to be further evaluated
in long-term follow-up studies.
Original source:
Christian Torbrand， Åsa Warnolf， Dominik Glombik et al.
Sentinel Node Identification with Hybrid Tracer-guided and Conventional Dynamic Sentinel Node Biopsy in Penile Cancer： A Prospective Study in 130 Patients from the Two National Referral Centres in Sweden.
Eur Urol Oncol.
Oct 2022
