Fluorescent Versus Radioguided Lymph Node Mapping in Bladder Cancer

Published:November 30, 2016DOI:



      The aim of the study was to compare 2 methods of the sentinel lymph node biopsy (SLNB) procedure in bladder cancer: we applied technetium radiocolloid (RadCol) detected by a gamma ray detection probe, and indocyanine green (ICG) detected by a near-infrared fluorescent (NIRF) camera.

      Material and Methods

      The SLNB was performed on 50 patients using the RadCol and the ICG, followed by a lymphadenectomy and a pathologic examination.


      In the analyzed group of 47 patients (3 patients were excluded owing to the lack of lymphatic drainage from the tumor), the SLNB was performed using the 2 methods. The ICG with a NIRF-guided camera detected all sentinel lymph nodes (SLNs) in 46 cases, whereas RadCol detected them in 45 cases. In 12 (25.6%) of 47 patients, the ICG-fluorescent method revealed more SLNs than the RadCol method. In 8 (17%) patients, the SLNs revealed in the ICG fluorescence were metastatic. In 3 (6.4%) patients, we found SLNs outside the standard lymphadenectomy template, but a histopathologic examination showed they were negative for cancer. In 3 (6.4%) patients, the SLNs detected by both methods were negative for cancer, but other resected lymph nodes revealed metastases.


      Our study shows that SLNB procedure with the RadCol or the ICG method is useful for the evaluation of lymph nodes in bladder cancer. The new ICG fluorescent technique with a NIRF camera system is safe, enables live view of the results of the procedure, and does not create additional costs. However, it highlights more lymph nodes than the radioactive method.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Genitourinary Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Torre L.A.
        • Bray F.
        • Siegel R.L.
        • et al.
        Global cancer statistics, 2012.
        CA Cancer J Clin. 2015; 65: 87-108
        • Witjes J.A.
        • Compérat E.
        • Cowan N.C.
        • et al.
        • European Association of Urology
        EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines.
        Eur Urol. 2014; 65: 778-792
        • van der Pas M.H.
        • Meijer S.
        • Hoekstra O.S.
        • et al.
        Sentinel-lymph-node procedure in colon and rectal cancer: a systematic review and meta-analysis.
        Lancet Oncol. 2011; 12: 540-550
        • Schaafsma B.E.
        • Verbeek F.P.
        • Elzevier H.W.
        • et al.
        Optimization of sentinel lymph node mapping in bladder cancer using near-infrared fluorescence imaging.
        J Surg Oncol. 2014; 110: 845-850
        • Morton D.L.
        • Thompson J.F.
        • Cochran A.J.
        • et al.
        Final trial report of sentinel-node biopsy versus nodal observation in melanoma.
        N Engl J Med. 2014; 370: 599-609
        • Galimberti V.
        • Cole B.F.
        • Zurrida S.
        • et al.
        • International Breast Cancer Study Group Trial 23-01 investigators
        Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial.
        Lancet Oncol. 2013; 14: 297-305
        • Yashiro M.
        • Matsuoka T.
        Sentinel node navigation surgery for gastric cancer: overview and perspective.
        World J Gastrointest Surg. 2015; 7: 1-9
        • Oh S.Y.
        • Kim do Y.
        • Kim Y.B.
        • et al.
        Clinical application of sentinel lymph node mapping in colon cancer: in vivo vs. ex vivo techniques.
        Ann Surg Treat Res. 2014; 87: 118-122
        • Sherif A.
        • De La Torre M.
        • Malmstrom P.U.
        • et al.
        Lymphatic mapping and detection of sentinel nodes in patients with bladder cancer.
        J Urol. 2001; 166: 812-815
        • Van Den Berg N.S.
        • Buckle T.
        • Kleinjan G.I.
        • et al.
        Hybrid tracers for sentinel node biopsy.
        Q J Nucl Med Mol Imaging. 2014; 58: 193-206
        • Reinhart M.B.
        • Huntington C.R.
        • Blair L.J.
        • et al.
        Indocyanine green: historical context, current applications, and future considerations.
        Surg Innov. 2016; 23: 166-175
        • Polom K.
        • Murawa D.
        • Rho Y.S.
        • et al.
        Current trends and emerging future of indocyanine green usage in surgery and oncology: a literature review.
        Cancer. 2011; 117: 4812-4822
        • Schaafsma B.E.
        • Mieog J.S.
        • Hutteman M.
        • et al.
        The clinical use of indocyanine green as a near-infrared fluorescent contrast agent for image-guided oncologic surgery.
        J Surg Oncol. 2011; 104: 323-332
        • Polom W.
        • Markuszewski M.
        • Rho Y.S.
        • et al.
        Usage of invisible near infrared light (NIR) fluorescence with indocyanine green (ICG) and methylene blue (MB) in urological oncology. Part 1.
        Cent European J Urol. 2014; 67: 142-148
        • Kitai T.
        • Inomoto T.
        • Miwa M.
        • et al.
        Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer.
        Breast Cancer. 2005; 12: 211-215
        • Malmström P.U.
        • Ren Z.P.
        • Sherif A.
        • et al.
        Early metastatic progression of bladder carcinoma: molecular profile of primary tumor and sentinel lymph node.
        J Urol. 2002; 168: 2240-2244
        • Marits P.
        • Karlsson M.
        • Sherif A.
        • et al.
        Detection of immune responses against urinary bladder cancer in sentinel lymph nodes.
        Eur Urol. 2006; 49: 59-70
        • Sherif A.
        • Garske U.
        • de la Torre M.
        • et al.
        Hybrid SPECT-CT: an additional technique for sentinel node detection of patients with invasive bladder cancer.
        Eur Urol. 2006; 50: 83-91
        • Liedberg F.
        • Chebil G.
        • Davidsson T.
        • et al.
        Intraoperative sentinel node detection improves nodal staging in invasive bladder cancer.
        J Urol. 2006; 175: 84-88
        • Roth B.
        • Wissmeyer M.P.
        • Zehnder P.
        • et al.
        A new multimodality technique accurately maps the primary lymphatic landing sites of the bladder.
        Eur Urol. 2010; 57: 205-211
        • Knapp D.W.
        • Adams L.G.
        • Degrand A.M.
        • et al.
        Sentinel lymph node mapping of invasive urinary bladder cancer in animal models using invisible light.
        Eur Urol. 2007; 52: 1700-1708
        • Motomura K.
        • Inaji H.
        • Komoike Y.
        • et al.
        Combination technique is superior to dye alone in identification of the sentinel node in breast cancer patients.
        J Surg Oncol. 2001; 76: 95-99
        • Markuszewski M.
        • Polom W.
        • Cytawa W.
        • et al.
        Comparison of real-time fluorescent indocyanine green and (99m) tc-nanocolloid radiotracer navigation in sentinel lymph node biopsy of penile cancer.
        Clin Genitourin Cancer. 2015; 13: 574-580
        • Hojo T.
        • Nagao T.
        • Kikuyama M.
        • et al.
        Evaluation of sentinel node biopsy by combined fluorescent and dye method and lymph flow for breast cancer.
        Breast. 2010; 19: 210-213
        • Polom K.
        • Murawa D.
        • Rho Y.S.
        • et al.
        Skin melanoma sentinel lymph node biopsy using real-time fluorescence navigation with indocyanine green and indocyanine green with human serum albumin.
        Br J Dermatol. 2012; 166: 682-683
        • van der Poel H.G.
        • Buckle T.
        • Brouwer O.R.
        • et al.
        Intraoperative laparoscopic fluorescence guidance to the sentinel lymph node in prostate cancer patients: clinical proof of concept of an integrated functional imaging approach using a multimodal tracer.
        Eur Urol. 2011; 60: 826-833
        • Inoue S.
        • Shiina H.
        • Mitsui Y.
        • et al.
        Identification of lymphatic pathway involved in the spread of bladder cancer: evidence obtained from fluorescence navigation with intraoperatively injected indocyanine green.
        Can Urol Assoc J. 2013; 7: E322-E328
        • Manny T.B.
        • Hemal A.K.
        Fluorescence-enhanced robotic radical cystectomy using unconjugated indocyanine green for pelvic lymphangiography, tumor marking, and mesenteric angiography: the initial clinical experience.
        Urology. 2014; 83: 824-829
        • Lerner S.P.
        Editorial comment on: Sentinel lymph node mapping of invasive urinary bladder cancer in animal models using invisible light.
        Eur Urol. 2007; 52: 1708-1709