Technology Insight: radioguided sentinel lymph node dissection in the staging of prostate cancer (original) (raw)

Nature Clinical Practice Urology volume 3, pages 602–610 (2006)Cite this article

An Erratum to this article was published on 01 December 2006

Abstract

Pelvic lymph node dissection is the only reliable method of staging for clinically localized prostate cancer. Despite the obvious prognostic advantages conferred by accurate staging, pelvic lymph node dissection is associated with significant morbidity and prolonged operative time. A substantial decrease in the sensitivity to lymph node metastasis occurs by simple reduction of the dissection area to the obturator fossa. Radioguided sentinel lymph node dissection provides accurate staging despite use of a minimal-area dissection template. Results from studies in prostate cancer indicate that this method has a high sensitivity for very early detection of lymphatic spread. A substantial number of the detected metastases are of a small size, solitary and widely distributed throughout the pelvic lymph nodes. These features make metastases undetectable by preoperative imaging modalities, and by the current, standard method of lymph node dissection limited to the obturator fossa.

Key Points

This is a preview of subscription content, access via your institution

Access options

Subscribe to this journal

Receive 12 print issues and online access

$209.00 per year

only $17.42 per issue

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Additional access options:

Similar content being viewed by others

References

  1. Cerny JC et al. (1975) An evaluation of lymphangiography in staging carcinoma of the prostate. J Urol 3: 367–370
    Article Google Scholar
  2. Golimbu M et al. (1979) Extended pelvic lymphadenectomy for prostatic cancer. J Urol 5: 617–620
    Article Google Scholar
  3. Raghavaiah NV and Jordan WR (1979) Prostatic lymphography. J Urol 2: 178–181
    Article Google Scholar
  4. Allaf ME et al. (2004) Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer. J Urol 5: 1840–1844
    Article Google Scholar
  5. Bader P et al. (2003) Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? J Urol 3: 849–854
    Article Google Scholar
  6. Clark T et al. (2003) Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer. J Urol 1: 145–147
    Article Google Scholar
  7. Cabanas RM (1977) An approach for the treatment of penile carcinoma. Cancer 39: 456–466
    Article CAS Google Scholar
  8. Pettaway CA et al. (1995) Sentinel lymph node dissection for penile carcinoma: the MD Anderson Cancer Center experience. J Urol 6: 1999–2003
    Google Scholar
  9. Morton DL et al. (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 4: 392–399
    Article Google Scholar
  10. Alex JC and Krag DN (1993) Gamma-probe guided localization of lymph nodes. Surg Oncol 2: 137–143
    Article CAS Google Scholar
  11. Veronesi U et al. (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349: 546–553
    Article Google Scholar
  12. Horenblas S et al. (2000) Detection of occult metastasis in squamous cell carcinoma of the penis using a dynamic sentinel node procedure. J Urol 1: 100–104
    Article Google Scholar
  13. Wawroschek F et al. (1999) The sentinel lymph node concept in prostate cancer—first results of gamma probe-guided sentinel lymph node identification. Eur Urol 6: 595–600
    Article Google Scholar
  14. Strand SE and Persson BR (1979) Quantitative lymphoscintigraphy: basic concepts for optimal uptake of radiocolloids in the parasternal lymph nodes of rabbits. J Nucl Med 10: 1038–1046
    Google Scholar
  15. Paganelli G et al. (1998) Optimized sentinel node scintigraphy in breast cancer. QJ Nucl Med 1: 49–53
    Google Scholar
  16. Brossner C et al. (2001) Lymphatic drainage of prostatic transition and peripheral zones visualized on a three-dimensional workstation. Urology 2: 389–393
    Article Google Scholar
  17. Zuckier LS et al. (1990) Technetium-99m antimony sulphide colloid lymphoscintigraphy of the prostate by direct transrectal injection. Nucl Med Commun 9: 589–596
    Article Google Scholar
  18. Wawroschek F et al. (2003) Prostate lymphoscintigraphy for sentinel lymph node identification in canines: reproducibility, uptake, and biokinetics depending on different injection strategies. Urol Res 3: 152–158
    Google Scholar
  19. Wawroschek F et al. (2003) Prostate lymphoscintigraphy and radio-guided surgery for sentinel lymph node identification in prostate cancer. Technique and results of the first 350 cases. Urol Int 4: 303–310
    Article Google Scholar
  20. Mattei A et al. (2006) Number of prostatic sentinel lymph nodes outside of the areas of “limited” versus “extended” pelvic dissection [abstract #614]. Scientific programme of the 21st Annual Congress of the European Association of Urology.
  21. Corvin S et al. (2006) Laparoscopic sentinel lymph node dissection—a novel technique for the staging of prostate cancer. Eur Urol 2: 280–285
    Article Google Scholar
  22. Tiourina T et al. (1998) Evaluation of surgical gamma probes for radioguided sentinel node localisation. Eur J Nucl Med 9: 1224–1231
    Article Google Scholar
  23. Häcker A et al. Detection of pelvic lymph node metastases in patients with clinically localized prostate cancer: comparison of FCH PET/CT and laparoscopic radioisotope-guided sentinel lymph node dissection. J Urol, in press
  24. Querleu D et al. (1991) Laparoscopic pelvic lymphadenectomy in the staging of early carcinoma of the cervix. Am J Obstet Gynecol 2: 579–581
    Article Google Scholar
  25. Schuessler WW et al. (1991) Transperitoneal endosurgical lymphadenectomy in patients with localized prostate cancer. J Urol 5: 988–991
    Article Google Scholar
  26. Parra RO et al. (1992) Staging laparoscopic pelvic lymph node dissection. Experience and indications. Arch Surg 11: 1294–1297
    Article Google Scholar
  27. Kerbl K et al. (1993) Staging pelvic lymphadenectomy for prostate cancer: a comparison of laparoscopic and open techniques. J Urol 2: 396–398
    Article Google Scholar
  28. Kavoussi LR et al. (1993) Complications of laparoscopic pelvic lymph node dissection. J Urol 2: 322–325
    Article Google Scholar
  29. Jeschke S et al. (2005) Detection of early lymph node metastases in prostate cancer by laparoscopic radioisotope guided sentinel lymph node dissection. J Urol 6: 1943–1946
    Article Google Scholar
  30. Epstein JI et al. (1986) Frozen section detection of lymph node metastases in prostatic carcinoma: accuracy in grossly uninvolved pelvic lymphadenectomy specimens. J Urol 6: 1234–1237
    Article Google Scholar
  31. Partin AW et al. (1997) Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA 277: 1445–1451
    Article CAS Google Scholar
  32. Brenot-Rossi I et al. (2005) Limited pelvic lymphadenectomy using the sentinel lymph node procedure in patients with localised prostate carcinoma: a pilot study. Eur J Nucl Med Mol Imaging 6: 635–640
    Article Google Scholar
  33. Weingartner K et al. (1996) Anatomical basis for pelvic lymphadenectomy in prostate cancer: results of an autopsy study and implications for the clinic. J Urol 6: 1969–1971
    Google Scholar
  34. Takashima H et al. (2004) Validity of sentinel lymph node concept for patients with prostate cancer. J Urol 6: 2268–2271
    Article Google Scholar
  35. Wawroschek F et al. (2001) Radioisotope guided pelvic lymph node dissection for prostate cancer. J Urol 5: 1715–1719
    Article Google Scholar

Download references

Author information

Authors and Affiliations

  1. Fellow in Endourology and Laparoscopic Surgery, Department of Urology, Elisabethinen Hospital, Linz, Austria
    Avi Beri
  2. Professor and Chairman of the Department of Urology, Elisabethinen Hospital, Linz, Austria
    Günter Janetschek

Authors

  1. Avi Beri
    You can also search for this author inPubMed Google Scholar
  2. Günter Janetschek
    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence toAvi Beri.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

About this article

Cite this article

Beri, A., Janetschek, G. Technology Insight: radioguided sentinel lymph node dissection in the staging of prostate cancer.Nat Rev Urol 3, 602–610 (2006). https://doi.org/10.1038/ncpuro0625

Download citation

This article is cited by