Sentinel lymph node biopsy in renal malignancy: The past, present and future

Abstract

Sentinel lymph node biopsy (SLNB) is now an established technique in penile and pelvic cancers, resulting in a lower mortality and morbidity when compared with the traditional lymph node dissection. In renal cancer however, despite some early successes for the SLNB technique, paucity of data remains a problem, thus lymph node dissection and extended lymph node dissection remain the management of choice in clinically node positive patients, with surveillance of lymph nodes in those who are clinically node negative. SLNB is a rapidly evolving technique and the introduction of new techniques such as near infra-red fluorescence optical imaging agents and positron emission tomography/computed tomography scans, may improve sensitivity. Evidence in support of this has already been recorded in bladder and prostate cancer. Although the lack of large multi-centre studies and issues around false negativity currently prevent its widespread use, with evolving techniques improving accuracy and the support of large-scale studies, SLNB does have the potential to become an integral part of staging in renal malignancy.

Keywords: Sentinel lymph node biopsy; Dynamic sentinel node; Renal malignancy; Lymphoscintigraphy; Near infra-red fluorescence; Penile cancer; Lymphatic drainage

Core tip: A number of studies have examined the use of sentinel lymph node biopsy in urogenital malignancies. In penile and prostate cancer it has been found to be a valuable tool to aid staging and accurately predict prognosis. Its use in renal cancer is poorly explored and would benefit from a better understanding of the lymphatic drainage of the kidney. It is also proposed that modifications of the technique such as use of positron emission tomography/computed tomography scanning and near infra-red fluorescence optical imaging agents may further improve the technique making it a feasible option for use in renal malignancy.