Sentinel lymph node biopsy (SLNB) in pediatric Wilms tumor | 20 patients | 1-16 year old children w/ non-metastatic primary Wilms tumor | Prospective study | Single Center | Radio tracer injection was carried out after renal vein, artery and ureter ligation, at the time of radical nephrectomy. | Single sentinel lymph node (SLN) - 16 patients | Multiple SLN - 4 patients | The most common site of SLN was inter aortocaval space | Histopathology tumor involvement in 3 sentinel nodes (15%) | Lymph node involvement was not detected in cases w/ tumor free sentinel lymph node (no false negative case). | Ligating renal artery and vein prior to radiotracer injection to diminish the background confounding effect is suggested. | Conclusion: Intra-op SLNB is a safe & feasible tool to improve the accuracy of staging in pediatric Wilms tumor. | https://doi.org/10.1016/j.jpedsurg.2021.12.037 | Source: Sadeghi R et.al. | Department of Pediatric Surgery, Mashhad University of Medical Sciences, Akbar Children's Hospital, Mashhad, Iran | @EmTombash | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Sentinel lymph node biopsy in pediatric Wilms tumor
Infographic · Nov 2022 · 1 min read
In brief
In brief
This prospective study of 20 pediatric Wilms tumor patients demonstrates that intraoperative sentinel lymph node biopsy using radiotracer injection after vascular ligation is feasible and accurate for staging. The technique identified sentinel nodes in all patients with 15% positivity rate and no false negatives, suggesting it may improve staging accuracy compared to standard lymph node sampling alone.
- Sentinel lymph node biopsy detected nodal metastases in 15% of pediatric Wilms tumor cases with 100% negative predictive value (no false negatives).
- Ligating renal vessels before radiotracer injection reduces background activity and improves sentinel node detection accuracy during nephrectomy.
- Inter-aortocaval space was the most common sentinel node location; 80% of patients had a single identifiable sentinel lymph node.
- SLNB is safe and feasible in children 1-16 years old, potentially improving staging accuracy beyond standard lymph node sampling protocols.
- All patients with positive sentinel nodes had additional involved nodes removed during radical nephrectomy, confirming sentinel node as reliable staging indicator.
Written by the GCMD Library team from the infographic.
Multi-panel infographic with teal and yellow color scheme. Top section shows calendar icon and illustrated diverse children alongside patient demographics. Middle section displays anatomical kidney illustration with highlighted vessels. Bottom sections present key findings in text blocks with radioactive tracer icon and yellow conclusion box. Social media handles and journal branding appear at bottom.
Ramin Sadeghi, Reza Shojaeian, Mehran Hiradfar, Ahmad Mohammadipour, Ali Azadmand, Mahdi Parvizi Mashhadi
Introduction: Although the sentinel lymph node Biopsy (SLNB) is well stablished in solid tumors among adults but the experience on SLNB in pediatrics is still limited. In this article we report our experience of sentinel lymph node detection that is applied on pediatric solid renal tumors.
Material and methods: Twenty 1–16 year old children with non-metastatic primary Wilms tumor regarding the radiological studies were enrolled. Radio tracer injection was carried out after renal vein, artery and ureter ligation, at the time of radical nephrectomy. Sentinel node detection and sampling was performed in every location with radiotracer count of 3 times more than background. Finally lymph node sampling was completed following the standard current discipline in Wilms tumor surgery.
Results: A single SLN was detected in 16 patients. 4 patients had more than one SLN. The most common site of SLN was inter aortocaval space. Histopathologic studies revealed tumor involvement in 3 sentinel nodes (15%). All other lymph node samples were also studied histologically and LN involvement was not detected in any of the cases with tumor free sentinel lymph node (no false negative case). Multiple LN involvement was reported in two patients with positive SLN in which, other involved lymph nodes were removed with the tumor during radical nephrectomy.
Conclusion: Intraoperative SLNB is a safe and feasible tool to improve the accuracy of staging in pediatric Wilms’ tumor. We suggest to ligate renal artery and vein prior to radiotracer injection to diminish the background confounding effect.