title: Sentinel node detection in muscle-invasive urothelial bladder cancer is feasible after neoadjuvant chemotherapy in all pT stages, a prospective multicenter report.
abstract: OBJECTIVE
  To determine whether sentinel node detection (SNd) in muscle-invasive urothelial bladder cancer (MIBC) can be performed in patients undergoing neoadjuvant chemotherapy (NAC) and determine whether SNd is feasible in all pT stages, including pT0.
  
  
  BACKGROUND
  Previous published series of SNd in MIBC have not included patients undergoing NAC, and systematic reports of pT0 patients w/wo NAC were absent. Translational immunological tumor research on MIBC focusing on SNd, in the era of NAC, requires technical feasibility. Additionally, SNd in MIBC requests further evaluations as a method for nodal staging.
  
  
  METHODS
  Ninety-nine patients with suspected urothelial MIBC were prospectively selected from six urological centers. After TUR-B and primary staging, 65 MIBC patients qualified for radical cystectomy. Precystectomy staging was cT2a-T4aN0M0, including 47 NAC patients and 18 chemo-naïve patients. All 65 patients underwent intraoperative SNd by peritumoral injection of 80 Mbq Technetium and Geiger probe detection. Postcystectomy staging was pT0-T4aN0-N2M0. SNs were defined by two calculations, SNdef1 and SNdef2.
  
  
  RESULTS
  Totally 1063 lymph nodes were removed (total SNs; 222-227). NAC patients with pT0 (n = 24) displayed a true positive detection in 91.7 % by either SNdef, with a median of 3.0 SNs. NACpT >0 patients had a true positive detection in 87 % (SNdef1) and 91.3 % (SNdef2). In a univariate analysis, patient group neither NAC nor tumor downstaging influenced detection rates, regardless of SN definition. In total eight patients, 4/22 metastatic nodes were SNs while 18/22 were non-SNs.
  
  
  CONCLUSIONS
  Sentinel node detection in MIBC is feasible also in NAC patients, regardless of pT stage. SNd played no role in nodal staging.
authors.affiliation: Department of Urology, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden.|Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenblatt
authors.affiliation: Department of Urology, Sundsvall Hospital, Sundsvall, Sweden.
authors.forename: Markus
authors.initials: M
authors.lastname: Johansson
authors.affiliation: Department of Urology, Västmanland Hospital, Västerås, Sweden.
authors.forename: Farhood
authors.initials: F
authors.lastname: Alamdari
authors.affiliation: Department of Urology, Länssjukhuset Ryhov, Jönköping, Sweden.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sidiki
authors.affiliation: Department of Urology, Akademiska University Hospital, Uppsala, Sweden.
authors.forename: Benny
authors.initials: B
authors.lastname: Holmström
authors.affiliation: Centre for Research and Development, Faculty of Medicine, Uppsala University, County Council of Gävleborg, Uppsala, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Hansson
authors.affiliation: Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden.
authors.forename: Janos
authors.initials: J
authors.lastname: Vasko
authors.affiliation: Department of Medicine, Unit for Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Marits
authors.affiliation: Department of Medicine, Unit for Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Susanne
authors.initials: S
authors.lastname: Gabrielsson
authors.affiliation: Department of Radiation Sciences, Umeå University, Umeå, Sweden.
authors.forename: Katrine
authors.initials: K
authors.lastname: Riklund
authors.affiliation: Department of Medicine, Unit for Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ola
authors.initials: O
authors.lastname: Winqvist
authors.affiliation: Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden. amir.m.sherif@gmail.com.
authors.forename: Amir
authors.identifier: http://orcid.org/0000-0002-3675-3050
authors.initials: A
authors.lastname: Sherif
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D015653:Cystectomy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D000071036:Sentinel Lymph Node / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D013548:Sweden; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*
keywords: Cisplatin; Cystectomy; Immunotherapy; Neoadjuvant therapy; Sentinel lymph node biopsy; Urinary bladder neoplasms