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 place of work:
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 the journal:
Ces Urol 2013; 17(1): 42-50
Category:
Original article
Summary
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.
Zdroje
1. Fleischmann A, Schobinger S, Schumacher M, et al. Survival in surgically treated, nodal positive prostate cancer patients is predicted by histopathological characteristics of the primary tumor and its lymph node metastases. Prostate 2009; 69: 352–362.
2. Heidenreich A, Bellmunt J, Bolla M, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localized disease. Eur Urol 2011; 59: 61–71.
3. Abdollah F, Sun M, Thuret R, et al. Decreasing rate and extent of lymph node staging in patients undergoing radical prostatectomy may undermine the rate of diagnosis of lymph node metastases in prostate cancer. Eur Urol 2010; 58: 882–892.
4. Mattei A, Fuechsel FG, Bhatta Dhar N, et al. The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol 2008; 53: 118–125.
5. Briganti A, Blute ML, Eastham JH, et al. Pelvic lymph node dissection in prostate cancer. Eur Urol 2009; 55: 1251–1265.
6. Heidenreich A, Ohlmann CH, Polyakov S. Anatomical extent of pelvic lymphadenectomy in patients undergoing radical prostatectomy. Eur Urol 2007; 52: 29–37.
7. Schumacher MC, Burkhard FC, Thalmann GN, et al. Good outcome for patients with few lymph node metastases after radical retropubic prostatectomy. Eur Urol 2008; 54: 344–352.
8. Fait V. Sentinelova biopsie a možnosti využiti v současne onkochirurgii. Klinická Onkologie 2008; 21: 5–19.
9. Staník M, Čapák I, Macík D, et al. Vyšetření sentinelové uzliny u karcinomu prostaty. Ces Urol 2011; 15(Suppl 2): 39.
10. Briganti A, Karakiewicz PI, Chun FK, et al. Percentage of positive biopsy cores can improve the ability to predict lymph node invasion in patients undergoing radical prostatectomy and extended pelvic lymph node dissection. Eur Urol 2007; 51: 1573–1581.
11. Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 1993; 2: 335–339.
12. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127: 392–399.
13. Wawroschek F, Vogt H, Weckermann D, Wagner T, Harzmann R. The sentinel lymph node concept in prostate cancer: first results of gamma probe guided sentinel lymph node identification. Eur Urol 1999; 36: 595–600.
14. Jarolím L, Verner P, Křížová H, et al. Lymfoscintigrafie sentinelových uzlin při radikální prostatektomii. Urológia 2004; 10: 33.
15. Šimša J. a kol. Sentinelová uzlina. Lymfadenektomie u solidních nádorů. 1.vyd. Praha: Maxdorf Jessenius 2010; 10–11.
16. Holl G, Dorn R, Wengenmair H, Weckermann D, Sciuk J. Validation of sentinel lymph node dissection in prostate cancer: experience in more than 2,000 patients. Eur J Nucl Med Mol Imaging 2009; 36: 1377–1382.
17. Fukuda M, Egawa M, Imao T, et al. Detection of sentinel node micrometastasis by step section and immunohistochemistry in patients with prostate cancer. J Urol 2007; 177: 1313–1317.
18. Jeschke S, Beri A, Grüll M, et al. Laparoscopic radioisotope-guided sentinel lymph node dissection in staging of prostate cancer. Eur Urol 2008; 58: 126–133.
19. Meinhardt W, Valdes Olmos RA, van der Poel HK, et al. Laparoscopic sentinel node dissection for prostate carcinoma: technical and anatomical observations. BJU 2008; 102: 714–717.
20. Weckermann D, Dorn R, Holl G, Wagner T, Harzmann R. Limitation of radioguided surgery in high-risk prostate cancer. Eur Urol 2007; 51: 1549–1558.
21. Liu LC, Lang JE, Lu Y, et al. Intraoperative frozen section analysis of sentinel lymph nodes in breast cancer patients. Cancer 2011; 117: 250–258.
22. Van Der Poel H, Buckle T, Brouwer OR, et al. Intraoperative laparoscopic fluorescence guidance to the sentinel lymph node in prostate cancer patiens: clinical proof of concept of an integrated functional imaging approach using a multimodal tracer. Eur Urol 2011; 60: 826–833.
23. Heidenreich A, Varga Z and Von Knobloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 2002; 167: 1681.
24. Makarov DV, Humphreys EB, Mangold LA, et al. Pathological outcomes and biochemical progression in men with T1c prostate cancer undergoing radical prostatectomy with prostate specific antigen 2.6 to 4.0 vs 4.1 to 6.0 ng/ml. J Urol 2006; 176: 554–558.
25. Cagiannos I, Karakiewicz P, Eastham JA, et al. A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer. J Urol 2003; 170: 1798–1803.
26. Joniau S, Van Den Bergh L, Lerut E, et al. Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol 2012, http://dx.doi.org/10.1016/j.eururo.2012.6.057.
27. Wawroschek F, Wagner T, Hamm M, et al. The influence of serial sections, immunohistochemistry and extension of pelvic lymph node dissection on the lymph node status in clinically localized prostate cancer. Eur Urol 2003; 43: 132–137.
28. Van Den Bergh L, Lerut E, Deroose CM, et al. Sentinel node procedure for lymph node staging in prostate cancer. Eur Urol Suppl 2012; 11: 1011.
29. Weckermann D, Wawroschek F, Harzmann R. Is there a need for pelvic lymph node dissection in low risk prostate cancer patients prior to definitive local therapy? Eur Urol 2005; 47: 45–50.
Štítky
Paediatric urologist Nephrology UrologyČlánok vyšiel v časopise
Czech Urology
2013 Číslo 1
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