Lymphatic Mapping In Genitourinary Cancer

Canabas described the pattern of lymphatic drainage from the penis using radiographic lymphangiography [22]. He found that this drainage occurred to ''sentinel lymph nodes'' in the superficial inguinal area. He was the first to use the term ''sentinel nodes'' in reference to lymph nodes draining a particular part of the body. His contention was that metastasis would occur first to this group of superficial inguinal nodes, so that if these nodes were normal, then all other nodes would also be normal. Subsequent studies showed a false-negative rate of 25% for this approach [75]. Work is continuing using radiocolloid or blue dye or both to map lymphatic drainage in patients with penile cancer to locate the actual sentinel node or nodes, just as has been done in melanoma and breast cancer [76].

Some early experience in patients with vulva cancer has been encouraging and suggests that this technique can be successfully applied to patients with this malignancy [77,78]. There have also been promising descriptions of the application of lymphatic mapping techniques in the abdominal cavity in patients with high-risk endometrial cancer which have shown that the sentinel nodes in the pelvis, common iliac, and para-aortic area can be identified [79]. Other studies are proceeding to confirm the accuracy of this method in uterine cancer. It is hoped that sentinel lymphadenectomy can in this way replace the current approach of random node sampling. It might also be possible in the future to map the lymphatic drainage pathways from malignancies in other intra-abdominal sites such as the bladder and prostate, and even the large bowel.

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