Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
EJNMMI Research
Published in: EJNMMI Research 1/2018

Open Access 01-12-2018 | Original research

An analysis of SPECT/CT non-visualization of sentinel lymph nodes in renal tumors

Authors: Teele Kuusk, Maarten L. Donswijk, Renato A. Valdés Olmos, Roderick E. De Bruijn, Oscar R. Brouwer, Kees Hendricksen, Simon Horenblas, Katarzyna Jóźwiak, Warner Prevoo, Henk G. Van Der Poel, Bas W. G. Van Rhijn, Esther M. Wit, Axel Bex

Published in: EJNMMI Research | Issue 1/2018

Login to get access

Abstract

Background

Sentinel lymph node biopsy (SLNB) after intratumoral injection of 99mTc labeled nanocolloid and imaging with scintigraphy and SPECT/CT in renal tumors is feasible. However, sentinel lymph node (SN) non-detection rate with scintigraphy and SPECT/CT is high. The aim of the study was to determine factors affecting non-visualization (NV) of SN imaging in renal tumors. Seventy-eight patients with cT1–3 renal tumors received intratumoral injection of 225 MBq 99mTc-labeled nanocolloid 1 day before (partial) nephrectomy. Radiotracer injection was followed by anterioposterior and lateral scintigraphy in combination with SPECT/CT 20 min and 2–4 h after. Surgical treatment of the tumor with sentinel lymph node biopsy by aid of γ-probe and-camera was performed the next day. Scintigraphy and SPECT/CT images were evaluated and patient, tumor, and procedure characteristics were collected for 73 eligible patients used in uni- and multivariable analysis of a potential association with NV.

Results

A total of 80 (mean 1.1, IQR 0–2, max 6) sentinel lymph nodes in 46 patients were detected with scintigraphy and SPECT/CT. Preoperative visualization rate and intraoperative detection rate was 63% [95% CI 50–73%] and 61% [95% CI 49–72%], respectively. In uni- and multivariable analysis, the only factor associated with non-visualization was age, showing higher odds of non-visualization with higher age.

Conclusion

Our study demonstrated that non-visualization of SNs in renal tumors is relatively high and is associated with patient age. Furthermore, kidneys and also its tumors are highly vascularized which may cause a wash-out effect that could be identified with decreased kidney-liver ratios. However, in our data, the effect was statistically inconclusive. Further studies are needed to improve visualization and standardize the procedure of SLNB in renal tumors. The percentage of NV limits the use of SLNB for research and clinical purposes in renal cancer.
Appendix
Available only for authorised users
Literature
1.
Gershman B, Moreira DM, Thompson RH, Boorjian SA, Lohse CM, Costello BA, Cheville JC, et al. Renal cell carcinoma with isolated lymph node involvement: long-term natural history and predictors of oncologic outcomes following surgical resection. Eur Urol. 2017;72:300–6.CrossRefPubMed
2.
Blute ML, Leibovich BC, Cheville JC, Lohse CM, Zincke H. A protocol for performing extended lymph node dissection using primary tumor pathological features for patients treated with radical nephrectomy for clear cell renal cell carcinoma. J Urol. 2004;172:465–9.CrossRefPubMed
3.
Blom JHM, Van Poppel H, Maréchal JM, Jacqmin D, Schröder FH, de Prijck L, et al. Radical nephrectomy with and without lymph-node dissection: final results of European Organization for Research and Treatment of Cancer (EORTC) randomized phase 3 trial 3088. Eur Urol. 2009;55:28–34.CrossRefPubMed
4.
Tilki D, Chandrasekar T, Capitanio U, Ciancio G, Daneshmand S, Gontero P, et al. Impact of lymph node dissection at the time of radical nephrectomy with tumor thrombectomy on oncological outcomes: results from the International renal cell carcinoma-venous Thrombus consortium (IRCC-VTC). Urol Oncol. 2018;36(2):79.e11–7.CrossRef
5.
Kuusk T, De Bruijn R, Brouwer RO, De Jong J, Donswijk M, Grivas N, et al. Lymphatic drainage from renal tumors in vivo: a prospective sentinel node study using SPECT/CT imaging. J Urol. 2018;199(6):1426–32.CrossRefPubMed
6.
Moschini M, Dell'Oglio P, Larcher A, Capitanio U. Lymph node dissection for renal cell carcinoma: what are we missing? Curr Opin Urol. 2016;26(5):424–31.CrossRefPubMed
7.
8.
Wit EMK, Acar C, Grivas N, Yuan C, Horenblas S, Liedberg F, et al. Sentinel node procedure in prostate cancer: a systematic review to assess diagnostic accuracy. Eur Urol. 2017;71(4):596–605.CrossRefPubMed
9.
INTERNATIONAL ATOMIC ENERGY AGENCY. Guided intraoperative Scintigraphic tumour targeting (GOSTT), IAEA human health series no. 29. Vienna: IAEA; 2014. p. 67–262.
10.
Brouwer OR, van der Poel HG, Bevers RF, van Gennep EJ, Horenblas S. Beyond penile cancer, is there a role for sentinel node biopsy in urological malignancies? Clin Transl Imaging. 2016;4(5):395–410.CrossRefPubMedPubMedCentral
11.
Bex A, Vermeeren L, de Windt G, Prevoo W, Horenblas S, Olmos RA. Feasibility of sentinel node detection in renal cell carcinoma: a pilot study. Eur J Nucl Med Mol Imaging. 2010;37:1117–23.CrossRefPubMed
12.
Sherif AM, Eriksson E, Thörn M, Vasko J, Riklund K, Ohberg L, Ljungberg BJ. Sentinel node detection in renal cell carcinoma. A feasibility study for detection of tumour-draining lymph nodes. BJU Int. 2012;109(8):1134–9.CrossRefPubMed
13.
Karmali RJ, Suami H, Wood CG, Karam JA. Lymphatic drainage in renal cell carcinoma: back to the basics. BJU Int. 2014;114(6):806–17.CrossRefPubMed
14.
Conway WC, Faries MB, Nicholl MB, Terando AM, Glass EC, Sim M, et al. Age-related lymphatic dysfunction in melanoma patients. Ann Surg Oncol. 2009;16(6):1548–52.CrossRefPubMedPubMedCentral
15.
Brenot-Rossi I, Houvenaeghel G, Jacquemier J, Bardou VJ, Martino M, Hassan-Sebbag N, Pasquier J. Nonvisualization of axillary sentinel node during lymphoscintigraphy: is there a pathologic significance in breast cancer? J Nucl Med. 2003;44(8):1232–7.PubMed
16.
Kroon BK, Valdes Olmos R, Nieweg OE, Horenblas S. Non-visualization of sentinel lymph nodes in penile carcinoma. Eur J Nucl Med Mol Imaging. 2005;32:1096–9.CrossRefPubMed
17.
Madu MF, Wouters MW, van Akkooi AC. Sentinel node biopsy in melanoma: current controversies addressed. Eur J Surg Oncol. 2017;43(3):517–33.CrossRefPubMed
18.
Acar C, Kleinjan GH, van den Berg NS, Wit EM, van Leeuwen FW, van der Poel HG. Advances in sentinel node dissection in prostate cancer from a technical perspective. Int J Urol. 2015;22:898–909.CrossRefPubMed
19.
20.
Brouwer OR, van den Berg NS, Matheron HM, van der Poel HG, van Rhijn BW, Bex A, et al. A hybrid radioactive and fluorescent tracer for sentinel node biopsy in penile carcinoma as a potential replacement for blue dye. Eur Urol. 2014;65(3):600–9.CrossRefPubMed
21.
Vermeeren L, Muller SH, Meinhardt W, Valdes Olmos RAE. Optimizing the colloid particle concentration for improved preoperative and intraoperative image-guided detection of sentinel nodes in prostate cancer. J Nucl Med Mol Imaging. 2010;37(7):1328–34.CrossRef
22.
Leijte JA, Kroon BK, Valdes Olmos RA, Nieweg OE, Horenblas S. Reliability and safety of current dynamic sentinel node biopsy for penile carcinoma. Eur Urol. 2007;52:170–7.CrossRefPubMed
23.
Sinnamon AJ, Neuwirth MG, Bartlett EK, Zaheer S, Etherington MS, Xu X, et al. Predictors of false negative sentinel lymph node biopsy in trunk and extremity melanoma. J Surg Oncol. 2017;116(7):848–55.CrossRefPubMed
24.
Tanis PJ, van Sandick JW, Nieweg OE, Valdés Olmos RA, Rutgers EJ, Hoefnagel CA, et al. The hidden sentinel node in breast cancer. Eur J Nucl Med Mol Imaging. 2002;29:305–11.CrossRefPubMed
25.
26.
Wit E, Kleinjan G, Donswijk M, Leeuwen Van F, Van Der Poel H. The influence of tracer injection into the prostate for the detection of lymph node metastases in prostate cancer during robot assisted radical prostatectomy with sentinel node procedure: a phase II randomized comparison. Eur Urol Suppl. 2018;17(2):e1161.CrossRef
27.
28.
Bodurtha Smith AJ, Fader AN, Tanner EJ. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(5):459–476.e10.CrossRefPubMed
29.
Garcia-Manero M, Olartecoechea B, Royo P. Different injection sites of radionuclide for sentinel lymph node detection in breast cancer: single institution experience. Eur J Obstet Gynecol Reprod Biol. 2010;153(2):185–7.CrossRefPubMed
30.
Bonsib SM. Renal lymphatics, and lymphatic involvement in sinus vein invasive (pT3b) clear cell renal cell carcinoma: a study of 40 cases. Mod Pathol. 2006;19(5):746–53.CrossRefPubMed
31.
Brouwer OR, Noe A, Olmos RA, Bex A. Lymphatic drainage from renal cell carcinoma along the thoracic duct visualized with SPECT/CT. Lymphat Res Biol. 2013;11:233–8.CrossRefPubMed
32.
Bex A, Vermeeren L, Meinhardt W, Prevoo W, Horenblas S, Valdés Olmos RA. Intraoperative sentinel node identification and sampling in clinically node-negative renal cell carcinoma: initial experience in 20 patients. World J Urol. 2011;29:793–9.CrossRefPubMed
Metadata
Title
An analysis of SPECT/CT non-visualization of sentinel lymph nodes in renal tumors
Authors
Teele Kuusk
Maarten L. Donswijk
Renato A. Valdés Olmos
Roderick E. De Bruijn
Oscar R. Brouwer
Kees Hendricksen
Simon Horenblas
Katarzyna Jóźwiak
Warner Prevoo
Henk G. Van Der Poel
Bas W. G. Van Rhijn
Esther M. Wit
Axel Bex
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
EJNMMI Research / Issue 1/2018
Electronic ISSN: 2191-219X
DOI
https://doi.org/10.1186/s13550-018-0460-y

Other articles of this Issue 1/2018

EJNMMI Research 1/2018 Go to the issue

Short Communication

Simplifying [18F]GE-179 PET: are both arterial blood sampling and 90-min acquisitions essential?

Original research

Effect of starvation on brain glucose metabolism and 18F-2-fluoro-2-deoxyglucose uptake: an experimental in-vivo and ex-vivo study

Original research

Renal sympathetic nerve activity after catheter-based renal denervation

Original research

First evaluation of PET-based human biodistribution and radiation dosimetry of 11C-BU99008, a tracer for imaging the imidazoline2 binding site

Original research

[18F]Fluciclovine PET discrimination between high- and low-grade gliomas

Original research

First in human evaluation of [18F]PK-209, a PET ligand for the ion channel binding site of NMDA receptors