Value of SPECT/CT for Detection and Anatomic Localization of Sentinel Lymph Nodes Before Laparoscopic Sentinel Node Lymphadenectomy in Prostate Carcinoma

Vermeeren, Lenka; Olmos, Renato A. Valdés; Meinhardt, W.; Bex, Axel; Poel, Henk G. van der; Vogel, Wouter V.; Sivro, Ferida; Hoefnagel, C.A.; Horenblas, Simon

doi:10.2967/jnumed.108.060673

Cited by 105 publications

(63 citation statements)

References 20 publications

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“…2C and 2D). Moreover, with SPECT/CT imaging, SLNs not seen on lymphoscintigraphic images, such as those in the presacral region, can be identified (17). As such, preoperative identification of the lymphatic drainage patterns allows surgeons to decide beforehand on the optimal and least invasive surgical approach.…”

Section: Preoperative Sln Identification and Planning Of The Surgicalmentioning

confidence: 99%

Sentinel Lymph Node Biopsy for Prostate Cancer: A Hybrid Approach

et al. 2013

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To provide surgeons with optimal guidance during interventions, it is crucial that the molecular imaging data generated in the diagnostic departments finds its way to the operating room. Sentinel lymph node (SLN) biopsy provides a textbook example in which molecular imaging data acquired in the department of nuclear medicine guides the surgical management of patients. For prostate cancer, in which SLNs are generally located deep in the pelvis, procedures are preferably performed via a (robotassisted) laparoscopic approach. Unfortunately, in the laparoscopic setting the senses of the surgeon are reduced. This topical review discusses technologic innovations that can help improve surgical guidance during SLN biopsy procedures. Metastasis in pelvic lymph nodes (LNs) is considered an important prognostic factor in prostate cancer. Prostatespecific antigen levels, pathologic stage, and Gleason score are predictors for LN involvement; the higher these factors are, the greater is the chance of nodal involvement. Postoperative (histo)pathologic examination of tissue samples obtained during (extended) pelvic lymphadenectomy is considered the gold standard in assessing metastatic spread. With an increasing LN dissection template, the prognosis of both N0 and N1 groups increases (Will Rogers phenomenon). Unfortunately, (extended) pelvic lymphadenectomy also increases the chance of postoperative complications such as lymphoceles, injuries to the obturator nerve or the ureter, and lymphedema of the lower extremity. Such complications can lead to a decrease in the patient's quality of life.Sentinel LN (SLN) biopsy focuses on the identification, subsequent minimally invasive excision, and pathologic and histopathologic evaluation of the LNs that drain directly from the primary tumor. Assuming the orderly spread of tumor cells through the lymphatic system, SLN biopsy can be used for LN staging. After staging, therapeutic follow-up can be decided on.The potential of SLN biopsy for detecting LN metastasis has been validated in several studies. The Augsburg group validated the SLN biopsy procedure in more than 2,000 patients with prostate cancer and reported a high sensitivity and an overall false-negative rate of 5.9% (1). Moreover, SLN biopsy allows the identification of SLNs outside the pelvic lymphadenectomy field (2-4). Recently, Joniau et al. showed that 44% of SLNs were located outside the extended pelvic lymphadenectomy field; in 6% of patients, a positive LN was located exclusively in the presacral or paraaortic region (2).Ideally, a surgeon is able to identify and excise the preoperatively identified SLNs in a minimally invasive manner, with a high sensitivity and specificity. This topical review discusses technologic improvements that may help improve the different aspects involved in (robot-assisted) laparoscopic SLN biopsy for prostate cancer; SLN biopsy for the prostate is often performed in combination with laparoscopic radical prostatectomy. Potential improvements can be found in (hybrid) tracers that are radioacti...

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Section: Preoperative Sln Identification and Planning Of The Surgicalmentioning

confidence: 99%

Sentinel Lymph Node Biopsy for Prostate Cancer: A Hybrid Approach

et al. 2013

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“…SPECT/CT not only provided useful anatomical information about the location of the sentinel nodes but also revealed sentinel nodes that had not been depicted on the conventional images. This was especially relevant for sentinel nodes outside the pelvic area and nodes in close proximity to the prostate, where a substantial number of sentinel nodes would have been missed without SPECT/CT [47]. Figure 4 shows an example of a presacral sentinel node that is only visualized on SPECT/CT images.…”

Section: Spect/ct In Patients With Other Malignanciesmentioning

confidence: 99%

“…Small studies have been performed in patients with urological and gynecological tumors and the investigators conclude that the new technique increases the yield of sentinel nodes [44][45][46]. We examined the use of additional SPECT/CT in 46 sentinel node procedures for prostate cancer [47]. SPECT/CT not only provided useful anatomical information about the location of the sentinel nodes but also revealed sentinel nodes that had not been depicted on the conventional images.…”

Section: Spect/ct In Patients With Other Malignanciesmentioning

confidence: 99%

SPECT/CT for preoperative sentinel node localization

Vermeeren

Ploeg

Olmos

et al. 2010

Journal of Surgical Oncology

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The value of SPECT/CT for detection and localization of sentinel nodes is reviewed. SPECT/CT depicts extra sentinel nodes and identifies nonnodal tracer accumulation. SPECT/CT is indicated in patients with complex lymphatic drainage as often present in patients with head, neck and scapular melanoma, breast cancer patients with extra-axillary sentinel nodes and patients with tumors draining to pelvic nodes. SPECT/CT also clarifies the drainage pattern of inconclusive conventional images (non-visualization or unclear location of the nodes).

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“…A disadvantage is that SN located near the site of injection can become obscured by the radioactive signal coming from the injection site. 32 …”

Section: Lymphoscintigraphymentioning

confidence: 99%

Advances in sentinel node dissection in prostate cancer from a technical perspective

et al. 2015

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Abbreviations & Acronyms ePLND = extended pelvic lymph node dissection FN = false negative ICG = indocyanine green LN = lymph node MRI = magnetic resonance imaging NIR = near-infrared NR = not reported PCa = prostate cancer PET = positron emission tomography PLND = pelvic lymph node dissection SN = sentinel node SPECT-CT = single-photon emission computed tomography combined with computed tomography TRUS = transrectal ultrasound Abstract: The most important feature of sentinel node biopsy for prostate cancer procedure is that staging can be improved. Sentinel nodes might be found outside the extended pelvic lymph node dissection template what renders the sentinel node additive of extended pelvic lymph node dissection. At the same time, staging within the template can be further refined. We reviewed the literature regarding the sentinel node biopsy procedure for prostate cancer. PubMed and Embase were searched for all Englishlanguage publications from January 1999 to September 2014 by using the keywords as "prostate cancer" and "sentinel lymph node" plus "biopsy" "dissection" and/or "procedure." The present review discusses step-by-step sentinel node biopsy for prostate cancer. Topics of discussion are: (i) preoperative sentinel node mapping (tracers and imaging); (ii) intraoperative sentinel node identification (surgical procedure and outcome); and (iii) novelties to improve sentinel node identification (pre-and intraoperative approaches). Conventional sentinel node mapping is carried out after the injection of a 99m Tc-based tracer and subsequent preoperative imaging; for example, lymphoscintigraphy and singlephoton emission computed tomography/computed tomography. This approach allowed the detection of sentinel nodes outside the extended lymph node dissection template in 3.6-36% of men with intermediate-and high-risk prostate cancer. Hereby, an overall false negative rate of sentinel nodes was reported between 0% and 24.4%. To further refine the intraoperative sampling procedure, novel imaging methods such as fluorescence imaging have been introduced. Prospective randomized comparison studies are required to confirm the added benefit of sentinel template directed nodal dissection. A proper and obtainable end-point of such a study could be the number of removed positive nodes for carrying out nodal dissection with or without sentinel template directed dissection. Similarly, the clinical impact of novel imaging technologies requires further investigation.

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Value of SPECT/CT for Detection and Anatomic Localization of Sentinel Lymph Nodes Before Laparoscopic Sentinel Node Lymphadenectomy in Prostate Carcinoma

Cited by 105 publications

References 20 publications

Sentinel Lymph Node Biopsy for Prostate Cancer: A Hybrid Approach

Sentinel Lymph Node Biopsy for Prostate Cancer: A Hybrid Approach

SPECT/CT for preoperative sentinel node localization

Advances in sentinel node dissection in prostate cancer from a technical perspective

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