Lymphatic drainage from the treated versus untreated prostate: feasibility of sentinel node biopsy in recurrent cancer

  • Lenka Vermeeren
  • Willem Meinhardt
  • Henk G. van der Poel
  • Renato A. Valdés Olmos
Original Article



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.


Lymphatic metastasis Prostatic neoplasms Radiotherapy Recurrence Sentinel lymph node biopsy 


Conflicts of interest



  1. 1.
    Weckermann D, Dorn R, Trefz M, Wagner T, Wawroschek F, Harzmann R. Sentinel lymph node dissection for prostate cancer: experience with more than 1,000 patients. J Urol 2007;177:916–20.CrossRefPubMedGoogle Scholar
  2. 2.
    Brenot-Rossi I, Bastide C, Garcia S, Dumas S, Esterni B, Pasquier J, et al. Limited pelvic lymphadenectomy using the sentinel lymph node procedure in patients with localised prostate carcinoma: a pilot study. Eur J Nucl Med Mol Imaging 2005;32:635–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Silva N Jr, Anselmi CE, Anselmi OE, Madke RR, Hunsche A, Souto JS, et al. Use of the gamma probe in sentinel lymph node biopsy in patients with prostate cancer. Nucl Med Commun 2005;26:1081–6.CrossRefPubMedGoogle Scholar
  4. 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
  5. 5.
    Corvin S, Schilling D, Eichhorn K, Hundt I, Hennenlotter J, Anastasiadis AG, et al. Laparoscopic sentinel lymph node dissection—a novel technique for the staging of prostate cancer. Eur Urol 2006;49:280–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Jeschke S, Nambirajan T, Leeb K, Ziegerhofer J, Sega W, Janetschek G. Detection of early lymph node metastases in prostate cancer by laparoscopic radioisotope guided sentinel lymph node dissection. J Urol 2005;173:1943–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Vermeeren L, Valdés Olmos RA, Meinhardt W, Bex A, van der Poel HG, Vogel WV, et al. Value of SPECT/CT for detection and anatomic localization of sentinel lymph nodes before laparoscopic sentinel node lymphadenectomy in prostate carcinoma. J Nucl Med 2009;50:865–70.CrossRefPubMedGoogle Scholar
  8. 8.
    van der Ploeg IM, Oldenburg HS, Rutgers EJ, Baas-Vrancken Peeters MJ, Kroon BB, Valdés Olmos RA, et al. Lymphatic drainage patterns from the treated breast. Ann Surg Oncol 2010;17:1069–75.CrossRefPubMedGoogle Scholar
  9. 9.
    van der Ploeg IM, Russell NS, Nieweg OE, Oldenburg HS, Kroon BB, Olmos RA, et al. Lymphatic drainage patterns in breast cancer patients who previously underwent mantle field radiation. Ann Surg Oncol 2009;16:2295–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Estourgie SH, Valdés Olmos RA, Nieweg OE, Hoefnagel CA, Rutgers EJ, Kroon BB. Excision biopsy of breast lesions changes the pattern of lymphatic drainage. Br J Surg 2007;94:1088–91.CrossRefPubMedGoogle Scholar
  11. 11.
    Tasevski R, Gogos AJ, Mann GB. Reoperative sentinel lymph node biopsy in ipsilateral breast cancer relapse. Breast 2009;18:322–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Axelsson CK, Jønsson PE. Sentinel lymph node biopsy in operations for recurrent breast cancer. Eur J Surg Oncol 2008;34:626–30.PubMedGoogle Scholar
  13. 13.
    Schrenk P, Tausch C, Wayand W. Lymphatic mapping in patients with primary or recurrent breast cancer following previous axillary surgery. Eur J Surg Oncol 2008;34:851–6.PubMedGoogle Scholar
  14. 14.
    Cox CE, Furman BT, Kiluk JV, Jara J, Koeppel W, Meade T, et al. Use of reoperative sentinel lymph node biopsy in breast cancer patients. J Am Coll Surg 2008;207:57–61.CrossRefPubMedGoogle Scholar
  15. 15.
    Port ER, Garcia-Etienne CA, Park J, Fey J, Borgen PI, Cody 3rd HS. Reoperative sentinel lymph node biopsy: a new frontier in the management of ipsilateral breast tumor recurrence. Ann Surg Oncol 2007;14:2209–14.CrossRefPubMedGoogle Scholar
  16. 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
  17. 17.
    Meinhardt W, Valdés Olmos RA, van der Poel HG, Bex A, Horenblas S. Laparoscopic sentinel node dissection for prostate carcinoma: technical and anatomical observations. BJU Int 2008;102:714–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Vermeeren L, Meinhardt W, Valdes Olmos RA. Prostatic lymphatic drainage with sentinel nodes at the ventral abdominal wall visualized with SPECT/CT: a case series. Clin Nucl Med 2010;35:71–3.CrossRefPubMedGoogle Scholar
  19. 19.
    Levavi H, Sabah G, Hardoff R, Koren C, Gutman H. Failure of sentinel node identification following neo-adjuvant chemo-radiotherapy for locally advanced squamous cell carcinoma of the vulva. Eur J Gynaecol Oncol 2003;24:433–4.PubMedGoogle Scholar
  20. 20.
    Wagner A, Kermer C, Zettinig G, Lang S, Schicho K, Noebauer I, et al. Validity of sentinel lymph node (SLN) detection following adjuvant radiochemotherapy (RCT) in head and neck squamous cell carcinoma (HNSCC). Technol Cancer Res Treat 2007;6:655–60.PubMedGoogle Scholar
  21. 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

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Lenka Vermeeren
    • 1
  • Willem Meinhardt
    • 2
  • Henk G. van der Poel
    • 2
  • Renato A. Valdés Olmos
    • 1
  1. 1.Department of Nuclear MedicineNetherlands Cancer Institute – Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  2. 2.Department of UrologyNetherlands Cancer Institute – Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands

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