Sentinel Node Biopsy in Clinical Stage I Testicular Cancer
Investigators report on long-term results of sentinel node (SN) approach in patients with clinical stage I testicular tumors.
Testicular cancer is the most common cancer in males 15 to 35 years of age. More than 7,900 men will receive a diagnosis of testicular cancer each year, and approximately 370 of those men will die from it. When diagnosed and treated early, however, testicular cancer is highly curable. This makes studies on diagnosis and treatment of testicular cancer especially important.
Investigators recently reported in BJU International on the long-term results of the sentinel node (SN) approach in patients with clinical stage I testicular tumors in a Netherlands cancer facility.
The authors analyzed 27 patients thought to have a clinical stage I testicular germ cell tumour (TGCT) who underwent an SN procedure at a tertiary referral center. Clinicians used lymphoscintigraphy with or without single-photon-emission computed tomography with CT (SPECT/CT) to identify SNs. Clinicians gave patients laparoscopic retroperitoneal SN excision with inguinal orchiectomy. Those with a tumor-positive SN were also given adjuvant therapy, and follow-up took place based on the guidelines of the time.
There were no SNs in two of the patients according to scintigraphy.
In the other 25 patients, a median (range) of 3 (1–4) SNs were removed from each patient. Of those 25, two were not found to have any malignancy in an examination of their testis.
Among the other 23 patients, all of whom were diagnosed with TGCT (16 seminomas,
seven non-seminomas), three (13.0%) were diagnosed with occult metastases. All 23 participants appeared disease free at a median range follow-up time of 63.9 (29.0–
143.4) months.
The authors conclude that a SN procedure provides for early detection of occult metastatic TGCT disease in clinical stage I, allowing the initiation of earlier treatment.
The next logical course of action following this study is to determine whether patients with a negative SN are subject to the risk of relapse. This will require a prospective study of a larger group, which the authors have begun the process for (www.clinicaltrials.gov identifier: NCT03448822).
Evaluation and Management of Testicular Cancer After Late Relapse
The clinical quandary by Langer et al discusses a contralateral late relapse of the original right nonseminomatous germ cell tumors.
In this edition of Clinical Quandaries, Regina Barragan-Carrillo, MD, and colleagues present a case of an 18-year-old man who has a 1-month history of nonpainful right testicular enlargement.
