Abstract
Introduction: Detection of lymph node status in bladder cancer significantly impacts clinical decisions regarding its management. There is a wide range of detection modalities for this task, including lymphoscintigraphy, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, positron emission tomography, and fluoroscopy. We aimed to study the pre- and intraoperative detection modalities of sentinel lymph nodes in urinary bladder cancer. Method: This narrative review was performed by searching the PubMed and EMBASE libraries using the following search terms: (“Transitional cell carcinoma of the bladder” OR “urothelial cancer” OR “urinary bladder cancer” OR “bladder cancer”) AND ((“sentinel lymph node”) OR (“lymphatic mapping”) OR (“lymphoscintigraphy”) OR (“lymphangiography”) OR (“lymph node metastases”)). Studies analysing the effectiveness and outcomes of sentinel lymph node detection in bladder cancer were included, while non-English language, duplicates, and non-article studies were excluded. After analysing the libraries and a further manual search of bibliographies, 31 studies were included in this paper. We followed the RAMESES publication standard for narrative reviews to produce this paper. Results: Of the 31 studies included, 7 studies included multiple detection methods; 5 studies included lymphoscintigraphy; 5 studies included computed tomography and/or single-photon emission computed tomography; 5 studies included fluoroscopy; 4 studies included magnetic resonance imaging; and 5 studies included positron emission tomography. Discussion: Anatomical, radioactive, and functional detection modalities have been studied independently and in combination. The consensus is that preoperative detection with imaging helps guide surgical management and intraoperative detection methods help capture any lymph nodes that may have been missed. Each of these types of detection represent their own set of benefits and drawbacks, but there is currently limited evidence to support any change in overall practice to replace conventional staging.
Highlights
Detection of lymph node status in bladder cancer significantly impacts clinical decisions regarding its management
As lymph node metastases are associated with negative prognosis, radical cystectomy is routinely combined with lymphadenectomy as routine management of Muscle invasive bladder cancer (MIBC) [5,6,8,9]
Lymphoscintigraphy is the detection of the gamma (y) radiation given off by radioactive tracers that are injected into the body
Summary
Detection of lymph node status in bladder cancer significantly impacts clinical decisions regarding its management. Bladder cancer is the fourth most common cancer in men and the tenth most common in women It has the highest lifetime cost per patient of all cancer types due to the longterm survival rate and intensive surveillance that is used [1]. Muscle invasive bladder cancer (MIBC) has a mortality rate of 50% over 5 years despite optimal management and no histopathologic signs of lymph node metastases [4,5]. This suggests half of patients have disease dissemination that is not detected by current staging techniques [6,7]. The extent of lymph node dissection is a highly debated topic, as it represents a fine balance between minimising disease spread with longer surgeries and complications, such as bleeding and lymphocoele development [8]
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