Sentinel lymph node biopsy in pediatric Wilms tumor
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Read the article on jpedsurg.org ↗Article · Jan 2022 · 1 min read
In brief
In brief
This prospective study demonstrates that intraoperative sentinel lymph node biopsy is feasible and accurate for staging pediatric Wilms tumor, with 100% sensitivity in 20 patients. The technique identified nodal involvement in 15% of cases with no false negatives, supporting its use to improve staging accuracy while potentially reducing unnecessary lymphadenectomy.
Written by the GCMD Library team from the article.
Introduction: Although the sentinel lymph node Biopsy (SLNB) is well stablished in solid tumors among adults but the experience on SLNB in pediatrics is still limited. In this article we report our experience of sentinel lymph node detection that is applied on pediatric solid renal tumors.
Material and methods: Twenty 1–16 year old children with non-metastatic primary Wilms tumor regarding the radiological studies were enrolled. At the time of radical nephrectomy, radio tracer injection was carried out after renal vein, artery and ureter ligation. Sentinel node detection and sampling was performed in every location with radiotracer count of 3 times more than background. Finally lymph node sampling was completed following the standard current discipline in Wilms tumor surgery.
Results: A single SLN was detected in 16 patients. 4 patients had more than one SLN. The most common site of SLN detection was inter aortocaval space. Histhopatologic studies revealed tumor involvement in 3 sentinel nodes (15%). All other lymph node samples were also studied and LN involvement was not detected in any of the cases with tumor free sentinel lymph node (no false negative case). Multiple LN involvement was reported in two patients with positive SLN in which, other involved lymph nodes were removed with the tumor during radical nephrectomy.
Conclusion: Intraoperative SLNB is a safe and feasible tool to improve the accuracy of staging in pediatric Wilms' tumor. We suggest to ligate renal artery and vein prior to radiotracer injection to diminish the background confounding effect.