https://www.europeanurology.com/article/S0302-2838(09)00244-9/pdf/pelvic-lymph-node-dissection-in-prostate-cancer

Pelvic Lymph Node Dissection in Prostate Cancer

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology.

/pdf/a-comprehensive-overview-of-radioguided-surgery-using-gamma-46u7urctug.pdf

A comprehensive overview of radioguided surgery using gamma detection probe technology

Sentinel Lymph Node Dissection for Prostate Cancer: Experience With More Than 1,000 Patients

Purpose: To prospectively evaluate the feasibility of magnetic resonance (MR) imaging with ferumoxtran-10 in patients with prostate cancer to depict lymph node metastases outside the routine pelvic lymph node dissection (PLND) area. Materials and Methods: The study was approved by the institutional review boards at all four hospitals; patients provided written informed consent. Two hundred ninety-six consecutive men (mean age, 67 years; range, 47–83 years) with prostate cancer and an intermediate-to-high risk for nodal metastases (prostate-specific antigen level >10 ng/mL, Gleason score >6, or stage T3 disease) were enrolled. MR lymphography of the pelvis was performed 24 hours after intravenous drip infusion of ferumoxtran-10. Positive nodes at MR lymphography were indicated to be inside or outside the routine dissection area (RDA). On the basis of MR lymphography computed tomographic (CT)–guided biopsy, routine PLND, or MR imaging–guided minimal extended PLND was performed. Results: MR lymphography find...

Prostate cancer: detection of lymph node metastases outside the routine surgical area with ferumoxtran-10-enhanced MR imaging

Laparoscopic evaluation of sentinel nodes is useful for staging prostate cancer, but preoperative localization of deep abdominal sentinel nodes with planar lymphoscintigraphy is difficult. We evaluated the value of SPECT/CT for detecting and localizing sentinel nodes in prostate cancer. Methods:99mTc-nanocolloid was injected peri- and intratumorally, guided by transrectal ultrasonography, in 46 patients with prostate cancer of intermediate prognosis. Patients underwent planar imaging after 15 min and 2 h, SPECT/CT after 2 h, and laparoscopic sentinel node lymphadenectomy on the same day. SPECT was fused with CT and analyzed using 2-dimensional orthogonal slicing and 3-dimensional volume rendering. We evaluated the number of extra sentinel nodes found by SPECT/CT, the number of sentinel nodes found by SPECT/CT outside the area of the extended pelvic lymphadenectomy, and the anatomic information provided by SPECT/CT. Furthermore, we classified the value of the additional SPECT/CT images into 3 categories (no advantage, presumable advantage, and definite advantage) according to the extra anatomic information given and whether additional sentinel nodes were found by SPECT/CT. Results: The patients had a mean age of 64 y (range, 53–74 y) and received a mean injected dose of 218 MBq (range, 147–286 MBq). The sentinel node visualization rate was 91% (42 patients) for planar imaging and 98% (45 patients) for SPECT/CT. In 29 of the 46 patients (63%), SPECT/CT revealed additional sentinel nodes (especially lymph nodes near the injection area) not seen on planar imaging. In 7 patients, those additional sentinel nodes were positive for metastasis (being the exclusive metastatic sentinel node in 4 patients). Overall, 15 patients (33%) had positive sentinel nodes. Sentinel nodes outside the area of extended pelvic lymphadenectomy were found in 16 patients (35%), whereas in 56% of these patients those nodes were not seen on planar imaging. Performing SPECT/CT had no advantage in 13% of the patients, a presumable advantage in 24%, and a definite advantage in 63%. Urologic surgeons used the SPECT/CT images to guide their trocar insertion sites and sentinel node finding with the probe. Conclusion: More sentinel nodes can be detected with SPECT/CT than with planar imaging alone. In comparison with planar imaging, SPECT/CT especially reveals extra sentinel nodes near the prostate and outside the area of the extended pelvic lymphadenectomy. Furthermore, the modality provides useful additional information about the anatomic location of sentinel nodes within and outside the pelvic area, leading to improved intraoperative sentinel node identification.

https://jnm.snmjournals.org/content/jnumed/50/6/865.full.pdf

Value of SPECT/CT for Detection and Anatomic Localization of Sentinel Lymph Nodes Before Laparoscopic Sentinel Node Lymphadenectomy in Prostate Carcinoma

Purpose
The purpose of this study was to determine the potential role of the sentinel lymph node (SLN) procedure in limited lymph node dissection in patients with apparently localised prostate carcinoma.

Limited pelvic lymphadenectomy using the sentinel lymph node procedure in patients with localised prostate carcinoma: a pilot study.

Objectif : Utiliser une technique isotopique de ganglion sentinelle dans le cancer de la prostate afin d'etudier sa faisabilite, le drainage lymphatique prostatique et l'interet dans le staging ganglionnaire pelvien. Materiel et Methode : 34 patients avec un cancer prostatique cliniquement localise ont eu une technique de ganglion sentinelle. La veille de la prostatectomie radicale, une injection intraprostatique de particules nanocolloidales marquees au Technetium 99m etait realisee par voie endorectale. Le reperage des ganglions sentinelles etait fait par lymphoscintigraphie et sonde gamma en peroperatoire. Une lymphadenectomie ilio-obturatrice standard etait faite systematiquement. Resultats : La lymphoscintigraphie preoperatoire a permis l'identification de ganglions sentinelles chez 85,3% des patients. Parmi les cinq echecs, quatre patients avaient un antecedent de chirurgie pelvienne. Le reperage et le prelevement des ganglions sentinelles (GS) ont ete possibles chez 23 patients (67,7%). La majorite des GS etait localisee dans la region hypogastrique (58,4%). Chez 4 patients (11,7%), une micro-metastase lymphatique a ete identifiee dont 3 etaient dans un GS. Dans deux cas, la micro-metastase se situait dans un GS en dehors de la region ilio-obturatrice. Ces quatre patients avaient un PSA pretherapeutique > 10 ng/ml et un score de Gleason > 7 (sur piece de prostatectomie). Conclusion: Cette etude a confirme la faisabilite de la technique du ganglion sentinelle dans le cancer de la prostate ainsi que la diversite du drainage lymphatique prostatique. Il semble egalement que le curage ilio-obturateur seul soit insuffisant pour un staging precis en cas de PSA pretherapeutique > 10ng/ml avec un score de Gleason > 6. Cette technique isotopique pourrait donc ameliorer la rentabilite du curage en limitant son etendue.

Feasibility and value of the isotope sentinel node mapping technique in prostate cancer

To evaluate mean change in best‐corrected visual acuity (BCVA) at 52 weeks in patients with inflammatory choroidal neovascularization (CNV) treated with aflibercept.

Efficacy and safety of Aflibercept for the treatment of inflammatory choroidal neovascularization: The ALINEA study

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Limited pelvic lymphadenectomy using the sentinel lymph node procedure in patients with localised prostate carcinoma: a pilot study.

Feasibility and value of the isotope sentinel node mapping technique in prostate cancer

Efficacy and safety of Aflibercept for the treatment of inflammatory choroidal neovascularization: The ALINEA study