Lymphatic Mapping for Endometrial Cancer

The staging for endometrial cancer is surgical and it should include both pelvic and para-aortic lymphadenectomy. The majority of endometrial cancers are diagnosed at early stage and lymphadenectomy gives no benefit for staging while adding surgical risks. Performing a systematic lymphadenectomy in very obese women is almost impossible. Preoperative lymphatic mapping (via planar lymphoscintigraphy, single photon emission computed tomography, or positron emission tomography) has poor correlation with surgical mapping of sentinel lymph nodes (SLNs), that has been proposed to avoid systematic lymphadenectomy in early stages. However, surgical SLN mapping is a very challenging procedure in endometrial cancer because the uterus has a complex lymphatic drainage. In the last 20 years, different authors used different tracers (vital stains, radioactive isotopes, or fluorescent dye), different sites of tracer injection (cervix, endometrium, or myometrium), and different surgical approaches (laparotomic, laparoscopic, or robotic) to find out the best procedure for SLNs identification. A well-designed, prospective, randomized, international multicenter tri¬al aimed at validating the accuracy of a uniform procedure is still lacking. In the meantime, to reduce the false-negative rate of intra-operative SLN mapping a surgical algorithm limits systematic pelvic lymphadenectomy to the hemi-pelvis without SLNs mapping and includes removal of any suspicious, although not mapped, node together with mapped SLNs

Detection of Lymph Node Metastases in Penile Cancer

Penile cancer (PC) is a relatively rare malignancy in the United States (US) but a greater concern in developing nations. Lymph node imaging remains critical to the staging and treatment of this disease as metastases develop in a predictable, anatomic fashion. Early surgical intervention remains a mainstay in treatment and imaging often aids in decision making. This review highlights the indications for imaging in both low-stage and advanced disease. Furthermore, we discuss the benefits and limitations of currently available imaging for staging of inguinal and pelvic lymph nodes in PC and novel modalities in development

Role of Sentinel Node Biopsy in Endometrial Cancer

Lymphadenectomy, for early stages of endometrial cancer (EC), provides a low detection rate of lymphatic metastasis, without having demonstrated a therapeutic effect; so that the collection and histological analysis of the sentinel lymph node (SLN) might be an alternative to lymphadenectomy. The contribution of SLN to surgical staging represents a change in the paradigm of lymphadenectomy in EC, being an intermediate approach between not assessing the condition of the lymph nodes and complete pelvic and paraaortic dissection. Accurate identification of the main uterine drainage pathway increases the likelihood of detecting metastases during lymphatic mapping. In addition, pathological assessment by the ultrastaging of the SLN is the most important advance in the SLN biopsy (SLNB) technique. The application of the SLNB presumes a decrease in surgical and long-term morbidity, with an increase in the detection of lymphatic metastasis, mainly at the expense of detecting low tumour volume, selecting the group of patients that would benefit from a modification in adjuvant therapy. The SLNB can be established as an oncologically safe and effective method in the surgical staging of early-stage EC. Prospective studies are required to determine optimal behaviour and prognosis in the detection of low-volume metastases

How molecular imaging will enable robotic precision surgery: the role of artificial intelligence, augmented reality, and navigation

Molecular imaging is one of the pillars of precision surgery. Its applications range from early diagnostics to therapy planning, execution, and the accurate assessment of outcomes. In particular, molecular imaging solutions are in high demand in minimally invasive surgical strategies, such as the substantially increasing field of robotic surgery. This review aims at connecting the molecular imaging and nuclear medicine community to the rapidly expanding armory of surgical medical devices. Such devices entail technologies ranging from artificial intelligence and computer-aided visualization technologies (software) to innovative molecular imaging modalities and surgical navigation (hardware). We discuss technologies based on their role at different steps of the surgical workflow, i.e., from surgical decision and planning, over to target localization and excision guidance, all the way to (back table) surgical verification. This provides a glimpse of how innovations from the technology fields can realize an exciting future for the molecular imaging and surgery communities.Imaging- and therapeutic targets in neoplastic and musculoskeletal inflammatory diseas

Methods of Sentinel Lymph Node Detection and Management in Urinary Bladder Cancer—A Narrative Review

© 2022 by the authors.Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/4.0/).Introduction: Detection of lymph node status in bladder cancer significantly impacts clinical decisions regarding its management. There is a wide range of detection modalities for this task, including lymphoscintigraphy, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, positron emission tomography, and fluoroscopy. We aimed to study the pre- and intraoperative detection modalities of sentinel lymph nodes in urinary bladder cancer. Method: This narrative review was performed by searching the PubMed and EMBASE libraries using the following search terms: (“Transitional cell carcinoma of the bladder” OR “urothelial cancer” OR “urinary bladder cancer” OR “bladder cancer”) AND ((“sentinel lymph node”) OR (“lymphatic mapping”) OR (“lymphoscintigraphy”) OR (“lymphangiography”) OR (“lymph node metastases”)). Studies analysing the effectiveness and outcomes of sentinel lymph node detection in bladder cancer were included, while non-English language, duplicates, and non-article studies were excluded. After analysing the libraries and a further manual search of bibliographies, 31 studies were included in this paper. We followed the RAMESES publication standard for narrative reviews to produce this paper. Results: Of the 31 studies included, 7 studies included multiple detection methods; 5 studies included lymphoscintigraphy; 5 studies included computed tomography and/or single-photon emission computed tomography; 5 studies included fluoroscopy; 4 studies included magnetic resonance imaging; and 5 studies included positron emission tomography. Discussion: Anatomical, radioactive, and functional detection modalities have been studied independently and in combination. The consensus is that preoperative detection with imaging helps guide surgical management and intraoperative detection methods help capture any lymph nodes that may have been missed. Each of these types of detection represent their own set of benefits and drawbacks, but there is currently limited evidence to support any change in overall practice to replace conventional staging.Peer reviewedFinal Published versio