ASCO GU 2018: Sentinel Node Biopsy in Clinical Stage I Testicular Cancer

San Francisco, CA ( There are nearly 9000 cases of testicular germ cell tumors in the United States yearly, with ~75% of patients presenting with stage I disease. However, of those patients that are clinically noted to have stage I disease on initial diagnosis, approximately 20% of patients with seminoma, and up to 30% of patients with non-seminoma harbor occult metastatic disease and will eventually relapse.  Because of these rates of relapse, some patients with clinical stage I disease will undergo either adjuvant chemotherapy or retroperitoneal lymph node dissection, both of which carry with them some chance of morbidity to the patient.  It would be beneficial for patients if we were able to better identify those patients who harbor occult metastases. 

As part of the rapid fire-abstract session for penile urethral, and testicular cancers, Dr. Joost Marijn Blok from the Netherlands presented data from a study performed at his institution which evaluated the role of sentinel retroperitoneal lymph node biopsy in men with testicular cancer.  The goal of the study was to evaluate if sentinel node biopsy led to earlier recognition of patients with occult metastatic disease.

23 men with either biopsy-proven seminoma or non-seminoma germ cell tumors underwent a laparoscopic retroperitoneal sentinel lymph node biopsy at the time of radical orchiectomy.  A radio-tracer was injected into the testis bearing the tumor and then lymphoscintigraphy using a SPECT/CT was performed to map the nodal drainage basin from the testis.  The patient then subsequently had sentinel lymph nodes resected based on the SPECT/CT imaging and with the use of a gamma probe. 

Of the 23 men with biopsy-proven testis cancer, 16 patients had seminoma whereas 7 had non-seminoma.  Of the 23 men in the study, 3 were noted to have occult metastatic disease in the sentinel lymph nodes.  Those patients with positive sentinel nodes subsequently underwent adjuvant BEP chemotherapy.  None of these men have evidence of relapse after treatment.  Of the 20 men who were sentinel node-negative, none have developed subsequent recurrence.  There were no Clavien 2+ surgical complications related to the node dissection. 

Dr. Blok concluded that the addition of sentinel node biopsy in men with testis cancer is safe and could potentially help us to earlier identify those men with occult metastatic disease. It additionally may allow for less stringent retroperitoneal imaging in men who have an initial negative sentinel node biopsy. 

Presented by: Joost Marijn Blok, MD

Written by: Brian Kadow, MD, Fox Chase Cancer Center, Philadelphia, PA at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA