Visualisation of the Lymph Node Pathway in Real Time by Laparoscopic Radioisotope- and Fluorescence-guided Sentinel Lymph Node Dissection in Prostate Cancer Staging

Jeschke, Stephan; Lusuardi, Lukas; Myatt, Andy; Hruby, Stephan; Pirich, Christian; Janetschek, Guenter

doi:10.1016/j.urology.2012.05.050

Cited by 107 publications

(84 citation statements)

References 26 publications

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“…3E). An excellent example of the spatial information that fluorescence imaging provides during laparoscopic surgery was demonstrated by Jeschke et al, who showed lymphatic tracts draining from the prostate to the SLN, as well as the SLN itself (25).…”

Section: Intraoperative Sln Identificationmentioning

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: Intraoperative Sln Identificationmentioning

confidence: 99%

Sentinel Lymph Node Biopsy for Prostate Cancer: A Hybrid Approach

et al. 2013

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“…Jeschke and co-workers have also shown the usefulness of analysing SNs using frozen section in prostate cancer patients (29). A limitation of the current study is that it was not designed to demonstrate whether all SNs could be detected in-vivo during the dissection, i.e.…”

Section: Discussionmentioning

confidence: 92%

“…A further development of the SN concept has recently been described by van der Poel and colleagues and Jeschke and co-workers, who independently demonstrated the feasibility of real-time laparoscopic SN detection using a combination of radioisotope and fluorescence guidance (28,29). Jeschke and co-workers have also shown the usefulness of analysing SNs using frozen section in prostate cancer patients (29).…”

Section: Discussionmentioning

confidence: 99%

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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“…21 In their study, they defined the SN as every node that was radioactive, fluorescent or both. In contrast, van der Poel et al defined the SN based on preoperative imaging only.…”

Section: Hybrid Tracermentioning

confidence: 99%

“…8,21 Tracers are administered per lobe or per quadrant, and can be targeted to the peripheral zone of the prostate 8 or throughout the whole prostate. 21 The number of injections per lobe varies from one to three (total 2-6 injections). Reported injected volumes range 0.2-3.0 mL (Table 1).…”

Section: Tracer Administrationmentioning

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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Visualisation of the Lymph Node Pathway in Real Time by Laparoscopic Radioisotope- and Fluorescence-guided Sentinel Lymph Node Dissection in Prostate Cancer Staging

Cited by 107 publications

References 26 publications

Sentinel Lymph Node Biopsy for Prostate Cancer: A Hybrid Approach

Sentinel Lymph Node Biopsy for Prostate Cancer: A Hybrid Approach

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

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

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