Lymphatic drainage from the treated versus untreated prostate: feasibility of sentinel node biopsy in recurrent cancer
- 166 Downloads
The goal of this study was to establish the feasibility of sentinel node biopsy in patients with recurrent prostate cancer after initial local treatment and to compare lymphatic drainage patterns of the treated versus untreated prostate.
In ten patients with a proven local recurrence after initial local treatment (four external beam radiation, four brachytherapy and two high-intensity focused ultrasound), the radiotracer (99mTc-nanocolloid, GE Healthcare) was injected into the prostate. Planar images after 15 min and 2 h were followed by SPECT/CT (Symbia T, Siemens) to visualize lymphatic drainage. Laparoscopic sentinel lymphadenectomy was assisted by a gamma probe (Europrobe, EuroMedical Instruments) and a portable gamma camera (Sentinella, S102, Oncovision). Sentinel node identification and lymphatic drainage patterns were compared to a consecutive series of 70 untreated prostate carcinoma patients from our institute.
Lymphatic drainage was visualized in all treated patients, with a median of 3.5 sentinel nodes per patient. Most sentinel nodes were localized in the pelvic area, although the percentage of patients with a sentinel node outside the pelvic para-iliac region (para-aortic, presacral, inguinal or near the ventral abdominal wall) was high compared to the untreated patients (80 versus 34%, p = 0.01). In patients with recurrent prostate cancer, 95% of the sentinel nodes could be harvested and half of the patients had at least one positive sentinel node on pathological examination.
Lymphatic mapping of the treated prostate appears feasible, although sentinel nodes are more frequently found in an aberrant location. Larger trials are needed to assess the sensitivity and therapeutic value of lymphatic mapping in recurrent prostate cancer.
KeywordsLymphatic metastasis Prostatic neoplasms Radiotherapy Recurrence Sentinel lymph node biopsy
Conflicts of interest
- 4.Warncke SH, Mattei A, Fuechsel FG, Z’Brun S, Krause T, Studer UE. Detection rate and operating time required for gamma probe-guided sentinel lymph node resection after injection of technetium-99m nanocolloid into the prostate with and without preoperative imaging. Eur Urol 2007;52:126–32.CrossRefPubMedGoogle Scholar
- 16.Graafland NM, Leijte JA, Valdés Olmos RA, van Boven HH, Nieweg OE, Horenblas S. Repeat dynamic sentinel node biopsy in locally recurrent penile carcinoma. BJU Int 2009: Epub ahead of print.Google Scholar
- 21.Hart RD, Henry E, Nasser JG, Trites JR, Taylor SM, Bullock M, et al. Sentinel node biopsy in N0 squamous cell carcinoma of the oral cavity and oropharynx in patients previously treated with surgery or radiation therapy: a pilot study. Arch Otolaryngol Head Neck Surg 2007;133:806–9.CrossRefPubMedGoogle Scholar