title: Intraoperative sentinel node detection improves nodal staging in invasive bladder cancer.
abstract: OBJECTIVE
  We evaluated intraoperative SN detection in patients with invasive bladder cancer during radical cystectomy in conjunction with extended lymphadenectomy.
  
  
  METHODS
  A total of 75 patients with invasive bladder cancer underwent radical cystectomy with extended lymphadenectomy. SNs were identified by preoperative lymphoscintigraphy, intraoperative dynamic lymphoscintigraphy and blue dye detection. An isotope (70 MBq (99m)Tc-nanocolloid) and Patent Blue(R) blue dye were injected peritumorally via a cystoscope. Excised lymph nodes were examined ex vivo using a handheld gamma probe. Identified SNs were evaluated by extended serial sectioning, hematoxylin and eosin staining, and immunohistochemistry.
  
  
  RESULTS
  At lymphadenectomy an average of 40 nodes (range 8 to 67) were removed. Of 75 patients 32 (43%) were lymph node positive, of whom 13 (41%) had all lymph node metastases located only outside of the obturator spaces. An SN was identified in 65 of 75 patients (87%). In 7 patients an SN was recognized when the nodal basins were assessed with the gamma probe after lymphadenectomy and cystectomy. Of the 32 lymph node positive cases 26 (81%) had a positive (metastatic) SN. Thus, the false-negative rate was 6 of 32 cases (19%). Five false-negative cases had macrometastases and/or perivesical metastases. In 9 patients (14%) the SN contained micrometastases (less than 2 mm), in 5 of whom the micrometastasis was the only metastatic deposit.
  
  
  CONCLUSIONS
  SN detection is feasible in invasive bladder cancer, although the false- negative rate was 19% in this study. Extended serial sectioning and immunohistochemistry revealed micrometastases in SNs in 9 patients and radio guided surgery after the completion of lymphadenectomy identified SNs in an additional 7. We believe that the technique that we used in this study improved nodal staging in these 16 of 65 patients (25%).
authors.affiliation: Department of Urology, Lund University Hospital, Lund, Sweden. fredrik.liedberg@skane.se
authors.forename: Fredrik
authors.initials: F
authors.lastname: Liedberg
authors.forename: Gunilla
authors.initials: G
authors.lastname: Chebil
authors.forename: Thomas
authors.initials: T
authors.lastname: Davidsson
authors.forename: Sigurdur
authors.initials: S
authors.lastname: Gudjonsson
authors.forename: Wiking
authors.initials: W
authors.lastname: Månsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*