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A Specific Mapping Study Using Fluorescence Sentinel Lymph Node Detection in Patients with Intermediate- and
Daniel P Nguyen1, Philipp M Huber1, Tobias A Metzger1
1Department of Urology, Bern University Hospital, Bern, Switzerland.
European Urology
|February 10, 2016
Summary
Sentinel lymph node mapping for prostate cancer using indocyanine green shows complex lymphatic drainage. This technique has low sensitivity for detecting metastases, indicating it cannot replace extensive pelvic lymph node dissection.
Area of Science:
- Urology
- Surgical Oncology
- Medical Imaging
Background:
- Sentinel lymph node (SLN) detection offers potential advancements in prostate cancer surgery.
- Controversy exists regarding the optimal extent of lymph node dissection (LND) during prostatectomy.
Purpose of the Study:
- To evaluate the utility of fluorescence SLN detection with indocyanine green (ICG) for identifying lymph node metastases in prostate cancer.
- To map the lymphatic drainage patterns of the prostate.
Main Methods:
- A lymphatic mapping study involving 42 intermediate- and high-risk prostate cancer patients undergoing radical prostatectomy.
- Systematic or specific ICG injections into various prostate regions.
- Analysis of SLN detection and lymph node metastasis in pelvic lymph nodes.
Main Results:
- The majority of SLNs were located in external and internal iliac regions, with up to 22% in common iliac regions.
- Prostatic lobes can drain to contralateral pelvic lymph nodes, and the fossa of Marcille receives significant drainage.
- In patients with systematic ICG injections, 55% sensitivity was achieved for detecting lymph node metastases, with 16 out of 29 positive nodes being ICG positive.
Conclusions:
- Prostate lymphatic drainage is complex, posing challenges for SLN techniques.
- The low sensitivity of ICG-based SLN detection suggests it is currently insufficient to replace extended pelvic LND in prostate cancer management.
