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A Specific Mapping Study Using Fluorescence Sentinel Lymph Node Detection in Patients with Intermediate- and High-risk Prostate Cancer Undergoing Extended Pelvic Lymph Node Dissection

European Urology, Volume 70, Issue 5, November 2016, Pages 734 - 737

Abstract

Sentinel lymph node (SLN) detection techniques have the potential to change the standard of surgical care for patients with prostate cancer. We performed a lymphatic mapping study and determined the value of fluorescence SLN detection with indocyanine green (ICG) for the detection of lymph node metastases in intermediate- and high-risk patients undergoing radical prostatectomy and extended pelvic lymph node dissection. A total of 42 patients received systematic or specific ICG injections into the prostate base, the midportion, the apex, the left lobe, or the right lobe. We found (1) that external and internal iliac regions encompass the majority of SLNs, (2) that common iliac regions contain up to 22% of all SLNs, (3) that a prostatic lobe can drain into the contralateral group of pelvic lymph nodes, and (4) that the fossa of Marcille also receives significant drainage. Among the 12 patients who received systematic ICG injections, 5 (42%) had a total of 29 lymph node metastases. Of these, 16 nodes were ICG positive, yielding 55% sensitivity. The complex drainage pattern of the prostate and the low sensitivity of ICG for the detection of lymph node metastases reported in our study highlight the difficulties related to the implementation of SNL techniques in prostate cancer.

Patient summary

There is controversy about how extensive lymph node dissection (LND) should be during prostatectomy. We investigated the lymphatic drainage of the prostate and whether sentinel node fluorescence techniques would be useful to detect node metastases. We found that the drainage pattern is complex and that the sentinel node technique is not able to replace extended pelvic LND.

Take Home Message

Fluorescence detection of the lymphatic landing sites of the prostate demonstrates a complex drainage pattern, suggesting that lymph node metastases do not follow a predefined pathway of metastatic spread. Our study also shows that the sensitivity of this technique to detect metastases is low.

Keywords: Indocyanine green, Lymphadenectomy, Prostate cancer, Sentinel lymph node, Mapping.

Footnotes

a Department of Urology, Bern University Hospital, Bern, Switzerland

b Institute of Pathology, Bern University Hospital, Bern, Switzerland

Corresponding author. Department of Urology, Bern University Hospital, CH-3010 Bern, Switzerland. Tel. +41 31 632 36 64; Fax: +41 31 632 21 80.

Both authors contributed equally.