University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany,
Institute of Diagnostic and Interventional Radiology, Klinikum Oldenburg, Oldenburg, Germany.
Urol Int. 2020;104(3-4):177-180. doi: 10.1159/000502017. Epub 2019 Jul 29.
In penile cancer, lymph node (LN) metastasis is the main known prognostic factor that affects survival. Inguinal sentinel LN (SLN) dissection (sLND) using radioactive marking is recommended by the European Association of Urology guidelines to evaluate the nodal status in clinically node-negative penile cancer (cN0; ≥pT1, G2). Dependence on radioisotopes limits the application of this procedure to small parts of the developed world, and imposes restrictions on hospital logistics. To overcome these issues, SLN visualization using magnetic resonance imaging (MRI) and magnetometer-guided detection after intraprostatic injection of superparamagnetic iron oxide nanoparticles (SPION) has been successfully applied in prostate cancer. Here, we present the first results of magnetic sLND in penile cancer. After peritumoral SPION injection, MR SLN imaging and magnetometer-guided sLND were performed in one cN0 penile cancer patient. Another patient underwent magnetometer-guided sLND only. In the first case, 5 SLNs could be visualized on MRI and intraoperatively detected by magnetometer-guided sLND. In the second patient, 3 SLNs could be detected by magnetic sLND. Neither patient exhibited adverse events attributable to SPION-injection. In conclusion, SPION-guided SLN identification using MRI and a handheld magnetometer is feasible and could provide a radiation-free technique for SLN identification in penile cancer. For further clarification, a multicenter study should be carried out.
在阴茎癌中，淋巴结 (LN) 转移是影响生存的主要已知预后因素。欧洲泌尿外科学会指南建议使用放射性标记进行腹股沟前哨淋巴结 (SLN) 解剖术 (sLND)，以评估临床无淋巴结转移的阴茎癌 (cN0; ≥pT1, G2) 的淋巴结状态。对放射性同位素的依赖限制了该程序在发达国家的小部分地区的应用，并对医院物流造成限制。为了克服这些问题，已经成功地将磁共振成像 (MRI) 用于 SLN 可视化，并在前列腺内注射超顺磁氧化铁纳米粒子 (SPION) 后使用磁力计引导检测，用于前列腺癌。在这里，我们介绍了在阴茎癌中进行磁性 sLND 的初步结果。在肿瘤周围注射 SPION 后，对一名 cN0 阴茎癌患者进行了 MRI 下 SLN 成像和磁力计引导下的 sLND，另一名患者仅进行了磁力计引导下的 sLND。在第一种情况下，MRI 可观察到 5 个 SLN，并可通过磁力计引导的 sLND 术中检测到。在第二种情况下，3 个 SLN 可以通过磁性 sLND 检测到。两名患者均未出现归因于 SPION 注射的不良事件。总之，使用 MRI 和手持磁力计进行 SPION 引导的 SLN 识别是可行的，可为阴茎癌的 SLN 识别提供一种无辐射的技术。为了进一步澄清，应该进行多中心研究。
