Opinion

Video

Lymph Node–Positive Kidney Disease: Future Implications of PET Imaging

Panelists discuss how the new PET technology could identify lymph node involvement not visible on conventional imaging, providing actionable information for surgical planning or indicating the need for systemic therapy rather than surgery alone.

Lymph Node Management and Molecular Imaging

Main Discussion Topics:

  • The current approach typically limits lymph node dissection to radiographically evident disease.
  • Molecular imaging could identify nodal disease missed by conventional imaging.
  • Detection of nodal disease by molecular imaging would be actionable.
  • Could influence surgical planning or shift patients toward systemic therapy approaches

Key Points for Physicians:

  • Neither expert routinely performs lymph node dissection without radiographic indication.
  • A positive node on molecular imaging would likely change management.
  • Options include targeted lymph node dissection or initiation of systemic therapy.
  • Improved node detection could help homogenize treatment groups in clinical trials.

Notable Insights:

Nodal disease detected by molecular imaging is considered biologically significant and likely indicates systemic disease requiring more than surgery alone.

Clinical Significance:

Molecular imaging could fundamentally change nodal staging and management decisions, potentially moving patients from surgery-first approaches to systemic therapy.

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