Current status of sentinel node biopsy in urological malignancies

Abstract

Like in most other malignancies the lymph node status is of outstanding prognostic relevance and an important tool for the determination of adjuvant strategies for urological tumor entities, too. Even in the era of PET/CT and MRI with iron oxid nano-particles the radiological imaging technology is strongly limited in cases of metastases smaller than 5 mm. Therefore only the operative lymph node exploration is suitable for an exact lymph node staging. The dilemma, however, is that the extended lymphadenectomy techniques feature a high morbidity and that any limitation of the dissection area results in a reduced detection rate of metastases in penile and prostate cancer. In contrast the sentinel- guided lymphadenectomy (SLND) offers a short operation time and a low morbidity without the risk of a significantly reduced detection of lymph node positive patients. As a consequence of many published papers dealing with a few thousands of patients the European Association of Urology (EAU) guidelines recommend the SLND in penile cancer (tumor stages ≥ T1G2) and as an option in prostate cancer. The latest studies of bladder, renal cell and testicular cancer promise the feasibility for these tumor entities, too. Up to which extend these thera- peutic concepts are able to replace or at least complement the default therapeutic procedures has to be shown in further studies.