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Lymphknotenmetastasendiagnostik bei urologischen Tumoren

Diagnostic work-up for lymph node metastases of urological tumors

Zusammenfassung

Sowohl die Computertomographie (CT) als auch die Magnetresonanztomographie (MRT) stellen derzeitig die am häufigsten verwendete und empfohlene LK-Stagingmodalität bei uroonkologischen Erkrankungen dar. Ihre diagnostische Wertigkeit ist insbesondere bei der Erkennung von Mikrometastasen sowie in Lymphknoten (LK) <10 mm eingeschränkt. Auch die FDG- und Cholin-basierten Positronenemissionstomographie (PET)/CT-Verfahren bieten hier keine wesentliche Verbesserung. Allerdings ist bei den Seminomen das PET/CT inzwischen in den Leitlinien implementiert (EAU) und wird bei Residualtumoren nach Chemotherapie für das weitere Management empfohlen. Ein großes Potential scheint die MRT mit lymphotrophen monokristallinen Eisenoxidnanopartikeln aufzuweisen, die kleinere Metastasen und Mikrometastasen auch in normalgroßen LK bei uroonkologischen Erkrankungen detektieren kann. Dennoch hat Guerbet einen Antrag auf Zulassung bei der EMEA für das Produkt Sinerem® („superparamagnetic iron oxide nanoparticles“) zurückgezogen. Ein vielversprechendes Verfahren stellt indes die diffusionsgewichtete MRT, die bereits außerhalb des urologischen Fachgebiets evaluiert wird.

Abstract

Both CT and MRI are currently the most frequently used and recommended modalities for lymph node staging of uro-oncological diseases. Their diagnostic usefulness is limited particularly for recognition of micrometastases and lymph nodes <10 mm. FDG- and choline-based PET/CT procedures also do not offer much improvement in these cases. Meanwhile however PET/CT has been included in the EAU guidelines for seminomas and is recommended for further management of residual tumors after chemotherapy. Magnetic resonance imaging with lymphotropic monocrystalline iron oxide nanoparticles appears to exhibit great potential and can detect smaller metastases and micrometastases even in normal-sized lymph nodes in uro-oncological diseases. Nevertheless, Guerbet has withdrawn its application to the EMEA for marketing authorization of its product Sinerem (superparamagnetic iron oxide nanoparticles). In the meantime diffusion-weighted MRI represents a promising technique and is already being evaluated in fields outside the realm of urology.

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Literatur

  1. 1.

    Krege S, Beyer J, Souchon R et al (2008) European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I. Eur Urol 53:478–96

  2. 2.

    Krege S, Beyer J, Souchon R et al (2008) European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part II. Eur Urol 53:497–513

  3. 3.

    Hilton S, Herr HW, Teitcher JB et al (1997) CT detection of retroperitoneal lymph node metastases in patients with clinical stage I testicular nonseminomatous germ cell cancer: assessment of size and distribution criteria. Am J Roentgenol 169:521–525

  4. 4.

    Sohaib SA, Koh DM, Husband JE (2008) The role of imaging in the diagnosis, staging, and management of testicular cancer. Am J Roentgenol 191:387–395

  5. 5.

    Huddart RA, O’Doherty MJ, Padhani A et al (2007) 18fluorodeoxyglucose positron emission tomography in the prediction of relapse in patients with high-risk, clinical stage I nonseminomatous germ cell tumors: preliminary report of MRC Trial TE22 – the NCRI Testis Tumour Clinical Study Group. J Clin Oncol 25:3090–3095

  6. 6.

    Oechsle K, Hartmann M, Brenner W et al (2008) [18F] Fluorodeoxyglucose positron emission tomography in nonseminomatous germ cell tumors after chemotherapy: the German multicenter positron emission tomography study group. J Clin Oncol 26:5930–5935

  7. 7.

    De Santis M, Becherer A, Bokemeyer C et al (2004) 2–18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol 22:1034–1039

  8. 8.

    Harisinghani MG, Saksena M, Ross RW et al (2005) A pilot study of lymphotrophic nanoparticle-enhanced magnetic resonance imaging technique in early stage testicular cancer: a new method for noninvasive lymph node evaluation. Urology 66:1066–1071

  9. 9.

    Kroon BK, Horenblas S, Lont AP et al (2005) Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol 173:816–819

  10. 10.

    Solsona E, Algaba F, Horenblas S et al (2004) EAU Guidelines on Penile Cancer. Eur Urol 46:1–8

  11. 11.

    Abbas S, Seitz M (2009) Systematic review and meta-analysis of the used surgical techniques to reduce leg lymphedema following radical inguinal nodes dissection. Surg Oncol 18(4):366–378

  12. 12.

    Ficarra V, Galfano A (2007) Should the dynamic sentinel node biopsy (DSNB) be considered the gold standard in the evaluation of lymph node status in patients with penile carcinoma? Eur Urol 52:17–21

  13. 13.

    Jensen JB, Jensen KM, Ulhoi BP et al (2009) Sentinel lymph-node biopsy in patients with squamous cell carcinoma of the penis. BJU Int 103:1199–1203

  14. 14.

    Leijte JA, Hughes B, Graafland NM et al (2009) Two-center evaluation of dynamic sentinel node biopsy for squamous cell carcinoma of the penis. J Clin Oncol 27:3325–3329

  15. 15.

    Leijte JA, Ploeg IM van der, Valdes Olmos RA et al (2009) Visualization of tumor blockage and rerouting of lymphatic drainage in penile cancer patients by use of SPECT/CT. J Nucl Med 50:364–367

  16. 16.

    Tabatabaei S, Harisinghani M, McDougal WS (2005) Regional lymph node staging using lymphotropic nanoparticle enhanced magnetic resonance imaging with ferumoxtran-10 in patients with penile cancer. J Urol 174:923–927

  17. 17.

    Scher B, Seitz M, Reiser M et al (2005) 18F-FDG PET/CT for staging of penile cancer. J Nucl Med 46:1460–1465

  18. 18.

    Schlenker B, Scher B, Tiling R et al (2009) Detection of inguinal lymph node involvement in penile squamous cell carcinoma by 18F-fluorodeoxyglucose PET/CT: A prospective single-center study. Urol Oncol (Epub ahead of print)

  19. 19.

    Mueller-Lisse UG, Mueller-Lisse UL, Meindl T et al (2007) Staging of renal cell carcinoma. Eur Radiol 17:2268–2277

  20. 20.

    Catalano C, Fraioli F, Laghi A et al (2003) High-resolution multidetector CT in the preoperative evaluation of patients with renal cell carcinoma. Am J Roentgenol 180:1271–1277

  21. 21.

    Turkvatan A, Akdur PO, Altinel M et al (2009) Preoperative staging of renal cell carcinoma with multidetector CT. Diagn Interv Radiol 15:22–30

  22. 22.

    Russo P (2000) Renal cell carcinoma: presentation, staging, and surgical treatment. Semin Oncol 27:160–176

  23. 23.

    Johnson CD, Dunnick NR, Cohan RH, Illescas FF (1987) Renal adenocarcinoma: CT staging of 100 tumors. Am J Roentgenol 148:59–63

  24. 24.

    Studer UE, Scherz S, Scheidegger J et al (1990) Enlargement of regional lymph nodes in renal cell carcinoma is often not due to metastases. J Urol 144:243–245

  25. 25.

    Ergen FB, Hussain HK, Caoili EM et al (2004) MRI for preoperative staging of renal cell carcinoma using the 1997 TNM classification: comparison with surgical and pathologic staging. Am J Roentgenol 182:217–225

  26. 26.

    Kang DE, White RL Jr, Zuger JH et al (2004) Clinical use of fluorodeoxyglucose F 18 positron emission tomography for detection of renal cell carcinoma. J Urol 171:1806–1809

  27. 27.

    Guimaraes AR, Tabatabei S, Dahl D et al (2008) Pilot study evaluating use of lymphotrophic nanoparticle-enhanced magnetic resonance imaging for assessing lymph nodes in renal cell cancer. Urology 71:708–712

  28. 28.

    Blom JH, Poppel H van, Marechal JM et al (2009) Radical nephrectomy with and without lymph-node dissection: final results of European Organization for Research and Treatment of Cancer (EORTC) randomized phase 3 trial 30881. Eur Urol 55:28–34

  29. 29.

    Karl A, Carroll PR, Gschwend JE et al (2009) The impact of lymphadenectomy and lymph node metastasis on the outcomes of radical cystectomy for bladder cancer. Eur Urol 55:826–835

  30. 30.

    Mills RD, Fleischmann A, Studer UE (2007) Radical cystectomy with an extended pelvic lymphadenectomy: rationale and results. Surg Oncol Clin N Am 16:233–245

  31. 31.

    Leissner J, Ghoneim MA, Abol-Enein H et al (2004) Extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study. J Urol 171:139–144

  32. 32.

    Abol-Enein H, El-Baz M, Abd El-Hameed MA et al (2004) Lymph node involvement in patients with bladder cancer treated with radical cystectomy: a patho-anatomical study – a single center experience. J Urol 172:1818–1821

  33. 33.

    El-Shazli S, Anwar H, Ramzy S, Al-Didi M (2004) Extended lymphadenectomy to the lower paraaortic nodes during radical cystectomy. J Egypt Natl Canc Inst 16:22–28

  34. 34.

    Feinstein AR, Sosin DM, Wells CK (1985) The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med 312:1604—1608

  35. 35.

    Stenzl A, Cowan NC, De Santis M et al (2009) The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol 55:815–825

  36. 36.

    Tsakiris P, Rosette J de la (2007) Imaging in genitourinary cancer from the urologists‘ perspective. Cancer Imaging 7:84–92

  37. 37.

    Kibel AS, Dehdashti F, Katz MD et al (2009) Prospective study of [18F] fluorodeoxyglucose positron emission tomography/computed tomography for staging of muscle-invasive bladder carcinoma. J Clin Oncol 27:4314–4320

  38. 38.

    Swinnen G, Maes A, Pottel H et al (2009) FDG-PET/CT for the preoperative lymph node staging of invasive bladder cancer. Eur Urol 55:826–835

  39. 39.

    Picchio M, Treiber U, Beer AJ et al (2006) Value of 11C-choline PET and contrast-enhanced CT for staging of bladder cancer: correlation with histopathologic findings. J Nucl Med 47:938–944

  40. 40.

    Deserno WM, Harisinghani MG, Taupitz M et al (2004) Urinary bladder cancer: preoperative nodal staging with ferumoxtran-10-enhanced MR imaging. Radiology 233:449–456

  41. 41.

    Thoeny HC, Triantafyllou M, Birkhaeuser FD et al (2009) Combined ultrasmall superparamagnetic particles of iron oxide-enhanced and diffusion-weighted magnetic resonance imaging reliably detect pelvic lymph node metastases in normal-sized nodes of bladder and prostate cancer patients. Eur Urol 55:761–769

  42. 42.

    Liedberg F, Chebil G, Davidsson T et al (2006) Intraoperative sentinel node detection improves nodal staging in invasive bladder cancer. J Urol 175:84–89

  43. 43.

    Bader P, Burkhard FC, Markwalder R, Studer UE (2002) Is a limited lymph node dissection an adequate staging procedure for prostate cancer? J Urol 168:514–518

  44. 44.

    Touijer K, Rabbani F, Otero JR et al (2007) Standard versus limited pelvic lymph node dissection for prostate cancer in patients with a predicted probability of nodal metastasis greater than 1%. J Urol 178:120–124

  45. 45.

    McLaughlin AP, Saltzstein SL, McCullough DL, Gittes RF (1976) Prostatic carcinoma: incidence and location of unsuspected lymphatic metastases. J Urol 115:89–94

  46. 46.

    Mattei A, Fuechsel FG, Bhatta Dhar N et al (2008) The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol 53:118–125

  47. 47.

    Heidenreich A, Aus G, Bolla M et al (2008) EAU guidelines on prostate cancer. Eur Urol 53:68–80

  48. 48.

    DiMarco DS, Zincke H, Sebo TJ et al (2005) The extent of lymphadenectomy for pTXNO prostate cancer does not affect prostate cancer outcome in the prostate specific antigen era. J Urol 173:1121–1125

  49. 49.

    Joslyn SA, Konety BR (2006) Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer. Urology 68:121–125

  50. 50.

    Allaf ME, Palapattu GS, Trock BJ et al (2004) Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer. J Urol 172:1840–1844

  51. 51.

    Bader P, Burkhard FC, Markwalder R, Studer UE (2003) Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? J Urol 169:849–854

  52. 52.

    Briganti A, Blute ML, Eastham JH et al (2009) Pelvic lymph node dissection in prostate cancer. Eur Urol 55:1251–1265

  53. 53.

    Hovels AM, Heesakkers RA, Adang EM et al (2008) The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 63:387–395

  54. 54.

    Scattoni V, Picchio M, Suardi N et al (2007) Detection of lymph-node metastases with integrated [11C] choline PET/CT in patients with PSA failure after radical retropubic prostatectomy: results confirmed by open pelvic-retroperitoneal lymphadenectomy. Eur Urol 52:423–429

  55. 55.

    Scher B, Seitz M, Albinger W et al (2007) Value of 11C-choline PET and PET/CT in patients with suspected prostate cancer. Eur J Nucl Med Mol Imaging 34:45–53

  56. 56.

    Schiavina R, Scattoni V, Castellucci P et al (2008) 11C-choline positron emission tomography/computerized tomography for preoperative lymph-node staging in intermediate-risk and high-risk prostate cancer: comparison with clinical staging nomograms. Eur Urol 54:392–401

  57. 57.

    Husarik DB, Miralbell R, Dubs M et al (2008) Evaluation of [(18)F]-choline PET/CT for staging and restaging of prostate cancer. Eur J Nucl Med Mol Imag 35:253–263

  58. 58.

    Harisinghani MG, Barentsz J, Hahn PF et al (2003) Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 348:2491–2499

  59. 59.

    Eiber M, Beer AJ, Holzapfel K et al (2010) Preliminary results for characterization of pelvic lymph nodes in patients with prostate cancer by diffusion-weighted MR-imaging. Invest Radiol 45:15–23

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Correspondence to PD Dr. M. Seitz.

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Seitz, M., Bader, M., Strittmatter, F. et al. Lymphknotenmetastasendiagnostik bei urologischen Tumoren. Urologe 49, 356–363 (2010). https://doi.org/10.1007/s00120-010-2271-2

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Schlüsselwörter

  • MRT
  • PET/CT
  • Uroonkologie
  • Prostatakarzinom
  • Hodentumor

Keywords

  • MRI
  • PET/CT
  • Uro-oncology
  • Prostate
  • RCC