Examination of the sentinel lymph node, mapping of the prostatic primary lymphatic drainage and assessment benefit of this diagnostic procedure for staging of the prostate cancer
Authors:
Michal Staník 1; Ivo Čapák 1; Daniel Macík 1; Karol Bolčák 2; Eva Lžičařová 3; Jiří Vašina 2; Martin Šustr 1; David Miklánek 1; Jan Doležel 1
Authors‘ workplace:
Oddělení onkourologie, Masarykův onkologický ústav, Brno
1; Oddělení nukleární medicíny, Masarykův onkologický ústav, Brno
2; Oddělení onkologické a experimentální patologie, Masarykův onkologický ústav, Brno
3
Published in:
Ces Urol 2013; 17(1): 42-50
Category:
Original article
Overview
Aim:
Sentinel lymph node (SLN) dissection replaces regional lymphadenectomy in early stages of many tumors. The objective of our study was to evaluate if the SLN dissection can improve staging of prostate cancer, define the regions of primary lymphatic drainage and correlate the staging accuracy of various templates of pelvic lymph node dissection (PLND).
Material and methods:
Fifty patients with estimated risk of lymphadenopathy above 5%, based on Briganti nomogram, were included in the study. On the day of surgery Tc-99m-labeled nanocolloid was injected into prostate and then the planar lymphoscintigraphy and single-photon emission computer tomography (SPECT) fused with CT images were performed to detect SLN. Patients then underwent SLN dissection and backup PLND.
Results:
We successfully detected the SLN in 96% of the patients. A total of 186 SLNs were localized by gamaprobe in course of the operation (mean value, 3,7 per patient). Lymph node (LN) metastases were found in 17 (34%) patients. Sensitivity of the procedure was 94.1% and it diagnosed additional micrometastases in 9/17 (53%) patients. Only 35.5% of primary LNs were found in obturator region. The extended PLND removeD 94.6% of primary LNs. SLN was identified in presacral and common iliac regions in only 3.2% and 2.2% respectively.
Conclusion:
SLN dissection shown high sensitivity in identifying LN metastases. The procedure improves staging by detecting higher number of micrometastases and allows to guide the dissection in presacral and internal iliac regions. Lymphatic mapping showed that extended PLND covers 95% of SLNs. PLND limited to obturator region is inadequate procedure as it removes only one third of SLNs.
Key words:
lymph node excision, prostatic neoplasms, sentinel lymph node biopsy.
Sources
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Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
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