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Lymphknotenmetastasendiagnostik bei urologischen Tumoren

Diagnostic work-up for lymph node metastases of urological tumors

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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 Nevertheless, Guerbet has withdrawn its application to the EMEA for marketing authorization of its product Sinerem (superparamagnetic iron oxide nanoparticles).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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  1. Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland

    M. Seitz, M. Bader, F. Strittmatter, C. Gratzke, D. Tilki, A. Roosen, B. Schlenker, O. Reich & C. Stief

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  1. M. Seitz
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  2. M. Bader
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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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