The Influence of Serial Sections, Immunohistochemistry, and Extension of Pelvic Lymph Node Dissection on the Lymph Node Status in Clinically Localized Prostate Cancer

Wawroschek, Friedhelm; Wagner, T.; Hamm, Michael W.; Weckermann, Dorothea; Vogt, Harry; Märkl, Bruno; Gordijn, Ronald; Harzmann, R.

doi:10.1016/s0302-2838(02)00450-5

Cited by 110 publications

(64 citation statements)

References 21 publications

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“…Extended serial sectioning and immunohistochemistry using anti-cytokeratin antibodies has been shown to increase the detection of metastases that are ≤ 2 mm in diameter (20,21). This has also been illustrated by computer simulations of SNs in breast cancer (22), and confirmed by another breast cancer study which showed that more extensive pathological analysis alone resulted in a 13% increase in detection of micrometastases (23).…”

Section: Discussionmentioning

confidence: 77%

Simplified intraoperative sentinel-node detection performed by the urologist accurately determines lymph-node stage in prostate cancer

Kjölhede

Bratt

Guðjónsson

et al. 2014

Scandinavian Journal of Urology

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Simplified intraoperative sentinel-node detection performed by the urologist accurately determines lymph-node stage in prostate cancer.Kjölhede, Henrik; Bratt, Ola; Gudjonsson, Sigurdur; Sundqvist, Pernilla; Liedberg, Fredrik Link to publication Citation for published version (APA): Kjölhede, H., Bratt, O., Gudjonsson, S., Sundqvist, P., & Liedberg, F. (2015). Simplified intraoperative sentinelnode detection performed by the urologist accurately determines lymph-node stage in prostate cancer. Scandinavian Journal of Urology, 49(2), 97-102. DOI: 10.3109/21681805.2014.968867 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal is currently an extended pelvic lymph node dissection (ePLND), which detects the majority, but not all, of regional lymph node metastases. As an alternative to ePLND, sentinel node (SN) dissection with preoperative isotope injection and imaging has been reported. The objective was to determine whether intraoperative SN detection with a simplified protocol can accurately determine lymph node stage in prostate cancer patients. Materials and methods:Patients with biopsy-verified high-risk prostate cancer with tumour stage T2-3 were included in the study. All patients underwent both ePLND and SN detection. 99m Tc-marked nanocolloid was injected peritumourally by the operating urologist after induction of anaesthesia just prior to surgery. SNs were detected both in-vivo and ex-vivo intraoperatively using a gamma probe. SNs and metastases and their locations were recorded. Sensitivity and specificity were calculated.Results: At least one SN was detected in 72 (87%) of the 83 patients. In 13 (18%) of these 72 patients SNs were detected outside the ePLND template. In six of these 13 patients, the SNs from outside the template contained metastases, which proved to be the only metastases in two. For 12 patients the only metastatic deposit found was a micrometastasis (≤ 2 mm) in a SN. In the 72 patients with detectable SNs, pathological analysis of the SNs correctly categorised 71 and ePLND 70 patients. Conclusions:This protocol yielded results comparable to the commonly used technique of SN detection, but with more cases of non-detection.

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Section: Discussionmentioning

confidence: 77%

Simplified intraoperative sentinel-node detection performed by the urologist accurately determines lymph-node stage in prostate cancer

Kjölhede

Bratt

Guðjónsson

et al. 2014

Scandinavian Journal of Urology

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“…Moreover, 8% of LN-positive patients would have been missed if a LN dissection in the presacral region had not been performed [15]. Accordingly, a significant number of SLNs could be visualized outside the standard node template in studies dealing with the radioactive marking approach [25,26]. Through the use of magnetic marking, a high proportion of SLNs could be visualized outside the established ePLND template.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Marking and Intraoperative Detection of Primary Draining Lymph Nodes in High-Risk Prostate Cancer Using Superparamagnetic Iron Oxide Nanoparticles: Additional Diagnostic Value?

Winter

Engels

Reinhardt

et al. 2017

Preprint

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Sentinel lymph node dissection (sLND) using a magnetometer and superparamagnetic iron oxide nanoparticles (SPIONs) as a tracer was successfully applied in prostate cancer (PCa). Radioisotope-guided sLND combined with extended pelvic LND (ePLND) achieved better node removal, increasing the number of affected nodes or the detection of sentinel lymph nodes outside the established ePLND template. We determined the diagnostic value of additional magnetometer-guided sLND after intraprostatic SPION-injection in high-risk PCa. This retrospective study included 104 high-risk PCa patients (PSA >20 ng/ml and/or Gleason score ≥8 and/or cT2c) from a prospective cohort who underwent radical prostatectomy with magnetometer-guided sLND and ePLND. The diagnostic accuracy of sLND was assessed using ePLND as a reference standard. Lymph node metastases were found in 61 of 104 patients (58.7%). sLND had a 100% diagnostic rate, 96.6% sensitivity, 95.6% specificity, 96.6% positive predictive value, 95.6% negative predictive value, 3.4% false negative rate, and 4.4% false positive rate (detecting lymph node metastases outside the ePLND template). These findings demonstrate the high sensitivity and additional diagnostic value of magnetometer-guided sLND, exceeding that of ePLND through the individualized extension of PLND or the detection of sentinel lymph nodes / lymph node metastases outside the established node template in high-risk PCa.

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“…45,59,63,64,[70][71][72][73] In 3 studies we found that an extended PLND was unnecessary. 58 In the randomized trial by Clark and colleagues, where patients had a limited PLND on one side and an extended PLND on the other side, there was no difference in the number of positive nodes between the limited and the extended PLND.…”

Section: Extentmentioning

confidence: 99%

Guideline for optimization of surgical and pathological quality performance for radical prostatectomy in prostate cancer management: evidentiary base

Chin

Srigley

Mayhew

et al. 2013

CUAJ

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Background: The objective is to provide surgical and pathological guidelines for radical prostatectomy (RP) with or without concurrent pelvic lymph node dissection (PLND) to achieve optimal benefit for patients, with minimal risk of harm. Methods:For surgical questions, a literature search of MEDLINE, EMBASE and the Cochrane database was performed. A literature search for the pathological questions was not conducted since the protocol for invasive carcinomas of the prostate gland developed by the College of American Pathologists (CAP) was endorsed. Urologists and pathologists were consulted for their assessment of the surgical and pathological recommendations. Results:Limited high-quality evidence from 95 primary studies was available and, therefore, the expert panel developed recommendations on the basis of a consensus of the expert opinion of the working group and through a consultation with urologists and pathologists. In addition to the CAP protocol, some technical recommendations related to the handling and processing of the specimen were made. Conclusion:Radical prostatectomy is recommended for the surgical treatment of prostate cancer, depending on a patient's preoperative risk profile. The panel unanimously determined that the goals for RP are to attain a positive margin rate of <25% for pT2 disease, a mortality rate of <1%, rates of rectal injury of <1% and blood transfusion rates of <10% in non-anemic patients. Standard PLND should be mandatory in high-risk patients, should be recommended for intermediate-risk patients and should be optional for low-risk patients. The quality and effectiveness of this treatment and of subsequent patient care depend on good management, effective communication and reporting between surgeons and pathologists working together as part of a multidisciplinary

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The Influence of Serial Sections, Immunohistochemistry, and Extension of Pelvic Lymph Node Dissection on the Lymph Node Status in Clinically Localized Prostate Cancer

Cited by 110 publications

References 21 publications

Simplified intraoperative sentinel-node detection performed by the urologist accurately determines lymph-node stage in prostate cancer

Simplified intraoperative sentinel-node detection performed by the urologist accurately determines lymph-node stage in prostate cancer

Magnetic Marking and Intraoperative Detection of Primary Draining Lymph Nodes in High-Risk Prostate Cancer Using Superparamagnetic Iron Oxide Nanoparticles: Additional Diagnostic Value?

Guideline for optimization of surgical and pathological quality performance for radical prostatectomy in prostate cancer management: evidentiary base

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