Intraoperative, radio-guided sentinel lymph node mapping in laparoscopic lymph node dissection for Stage I testicular carcinoma.
BACKGROUND
The management of regional lymph nodes in patients with clinical Stage I testicular carcinoma is a controversial problem. The authors investigated the feasibility and accuracy of radio-guided mapping of sentinel lymph nodes (SLNs) for men with clinical Stage I testicular tumors.


METHODS
Twenty-two patients with clinical Stage I testicular carcinoma were enrolled in the study. One day before surgery, (99m)Technetium-labeled phytate was injected around the testicular tumor. After undergoing radical orchiectomy, patients underwent laparoscopic retroperitoneal lymph node dissection (L-RPLND). All radioactive lymph nodes were marked in the L-RPLND procedure, and three-dimensional SLN maps were made. All resected lymph nodes were evaluated by routine histopathologic examination, and the clinical significance of intraoperative SLN mapping was evaluated.


RESULTS
SLNs were detected in 21 of 22 patients (95%). Nearly all SLNs were detected at the ventral or lateral side of the vena cava or at the aorta between the levels of the aortic bifurcation. All SLNs were detected easily in a surgical procedure. Only 1 radio-positive area per patient was identified in 15 patients, and approximately 2-4 positive areas were detected in 6 patients. Two patients had micrometastasis only in SLNs. In 2 patients who had seminoma, lymph node recurrences (at the level of the renal vein and in the obturator lymph node area) occurred at 10 months and 20 months after surgery.


CONCLUSIONS
Radio-guided mapping of SLNs with laparoscopy was feasible, and nearly all SLNs were detected accurately by the procedure. In the near future, the standard retroperitoneal lymph node dissection may be avoided in most patients with clinical Stage I testicular carcinoma by utilizing focused examination of SLNs.
Satoh
Makoto
M
Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan. msatoh@uro.med.tohoku.ac.jp
Ito
Akihiro
A
Kaiho
Yasuhiro
Y
Nakagawa
Haruo
H
Saito
Seiichi
S
Endo
Mareyuki
M
Ohyama
Chikara
C
Arai
Yoichi
Y
D000328:Adult; D001012:Aorta, Abdominal / Q000473:pathology; D002277:Carcinoma / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy; D015609:Organotechnetium Compounds; D010833:Phytic Acid; D010865:Pilot Projects; D015642:Radiology, Interventional; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D018239:Seminoma / Q000473:pathology / Q000556:secondary / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000473:pathology
D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C026177:technetium phytate; D010833:Phytic Acid