van Gennep Erik J, KleinJan Gijs H, Kuusk Teele, Verdijk Rick W A, Wit Esther M K, van Rhijn Bas W G, Bex Axel, Mertens Laura S
Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.
Homerton University Hospital London to now Addenbrooke's Hospital, Cambridge, UK.
BJU Int. 2025 Jul 12. doi: 10.1111/bju.16848.
To review the clinical utility, outcome and possible future applications of sentinel lymph node biopsy (SLNB) in penile cancer (PeC), bladder cancer (BCa), prostate cancer (PCa), testicular cancer (TCa) and renal cell carcinoma (RCC), focusing in particular on current SLNB standards and exploring advancements in imaging agents, intra-operative detection, surgical navigation, and the potential application of SLNB in translational and clinical research.
A literature search was conducted in PubMed and EMBASE for studies published between 2000 and 2024, providing a narrative review of SLNB in oncological urology.
In PeC, SLNB offers a lower adverse event rate compared to inguinal lymph node (LN) dissection, while maintaining high detection rates and acceptable sensitivity (92%-96%) for identifying inguinal LN metastases. Similarly, in PCa, SLNB achieves a sensitivity of 95%, potentially reinforcing its role in nodal staging and guiding personalised treatment strategies. For RCC, BCa and TCa, SLNB is currently under investigation in trials. In RCC, detection rates seem acceptable; however, in BCa and TCa, detection rates and false-negative rates vary, limiting its clinical usefulness. Contemporary approaches utilise various radiotracers, (fluorescent) dyes, and hybrid tracers for SLNB. Ongoing research refines tumour-targeted LN detection, including prostate-specific membrane antigen targeting in PCa, potential c-MET targeting in PeC, and Zr-girentuximab in RCC.
The use of SLNB has transformed nodal staging in PeC, influencing treatment decisions and reducing morbidity in patients undergoing surgery. In other urological malignancies, it has not yet established itself as a standard tool for nodal staging. Its impact on survival, quality of life, and translational research remains to be determined.
回顾前哨淋巴结活检（SLNB）在阴茎癌（PeC）、膀胱癌（BCa）、前列腺癌（PCa）、睾丸癌（TCa）和肾细胞癌（RCC）中的临床应用价值、结果及未来可能的应用，尤其关注当前的SLNB标准，并探讨成像剂、术中检测、手术导航方面的进展，以及SLNB在转化研究和临床研究中的潜在应用。
在PubMed和EMBASE中检索2000年至2024年发表的研究，对肿瘤泌尿学中的SLNB进行叙述性综述。
在PeC中，与腹股沟淋巴结清扫相比，SLNB的不良事件发生率较低，同时在识别腹股沟淋巴结转移方面保持较高的检出率和可接受的敏感性（92%-96%）。同样，在PCa中，SLNB的敏感性达到95%，可能会加强其在淋巴结分期和指导个性化治疗策略中的作用。对于RCC、BCa和TCa，SLNB目前正在试验中进行研究。在RCC中，检出率似乎可以接受；然而，在BCa和TCa中，检出率和假阴性率各不相同，限制了其临床应用价值。当代方法使用各种放射性示踪剂、（荧光）染料和混合示踪剂进行SLNB。正在进行的研究改进了肿瘤靶向淋巴结检测，包括PCa中的前列腺特异性膜抗原靶向、PeC中的潜在c-MET靶向以及RCC中的Zr-吉瑞替尼单抗靶向。
SLNB的应用改变了PeC的淋巴结分期，影响了治疗决策，并降低了手术患者的发病率。在其他泌尿生殖系统恶性肿瘤中，它尚未成为淋巴结分期的标准工具。其对生存率、生活质量和转化研究的影响仍有待确定。
