Surgical evaluation of lymph node metastases in Wilms' tumor.

Because lymph node (LN) involvement continues to be an adverse prognostic factor in the later National Wilms' Tumor Study (NWTS) trials, the NWTS-3 Surgical Committee undertook a project to determine the accuracy of the present method of sampling. The committee concludes that: (1) there is a relatively low potential error rate (less than 10%) that would comprise adequate care when a policy of LN sampling is followed; (2) this does not encourage routine radical LN dissections in Wilms' tumor patients because of the well-known morbidities associated with that procedure; and (3) LN sampling in all Wilms' tumor patients should be performed with a high index of suspicion present in the mind of the operating surgeon.