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

Abstract

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.

More extended lymph node dissection template at radical prostatectomy detects metastases in the common iliac region and in the fossa of Marcille

“…These findings support our LN mapping studies [6,16], speaking against the echelon theory that postulates that metastases do not occur in LNs of the second (common iliac vessels) or third echelon (paraaortal/paracaval) as long as the first echelon (areas caudal to the common iliac bifurcation) is free of tumour. In addition, over a century ago Cun eo and Marcille described three main paths draining the prostate [17]: lymphatics stretched along the external iliac vessels, internal iliac vessels and common iliac vessels.…”

Prospective evaluation of 68Gallium‐prostate‐specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer

“…Conventional imaging techniques are inadequate for LN staging in PCa. MRI, CT, positron emission tomography (PET)/CT and fluorescence sentinel lymph node detection are neither sensitive nor specific enough to reliably detect LN metastases before RP . Recent data on the novel PET tracer agent Glu‐NH‐CO‐NH‐Lys‐(Ahx)‐[68Ga(HBED‐CC)](PSMA) has shown promising sensitivity (33–85%) and specificity (82–100%) for both the detection of PCa recurrence and LN metastases .…”

“…In addition to staging, ePLND may also be curative, or at least beneficial, in a subset of patients with limited LN metastases [4,5]. metastases before RP [6][7][8][9]. Recent data on the novel PET tracer agent Glu-NH-CO-NH-Lys-(Ahx)-[68Ga(HBED-CC)] (PSMA) has shown promising sensitivity (33-85%) and specificity (82-100%) for both the detection of PCa recurrence and LN metastases [10][11][12][13][14][15][16].…”

Advanced Nanotechnology Leading the Way to Multimodal Imaging‐Guided Precision Surgical Therapy

“…Also, carbon NP suspension injection approved for LN mapping is extensively used by surgeons and researchers. [62,63] Many clinical trials have shown favorable results of intraoperative SLN detection with ICG, [64][65][66] even in robotassisted laparoscopic surgery. Radionuclide-labeled NMs for LN tracers have high sensitivity, but they are limited by the difficulty in distinguishing SLNs from other DLNs and radiation exposure to patients and doctors.…”