Skip to main content
SpringerLink
Log in

Limited pelvic lymphadenectomy using the sentinel lymph node procedure in patients with localised prostate carcinoma: a pilot study

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to determine the potential role of the sentinel lymph node (SLN) procedure in limited lymph node dissection in patients with apparently localised prostate carcinoma.

Methods

In 27 patients with organ-confined prostate cancer, a single injection of 0.3 ml/30 MBq 99mTc-rhenium sulphur colloid was injected transrectally into the peripheral zone of each lobe of the prostate (total 0.6 ml/60 MBq) under ultrasound guidance. Two hours after injection, scintigraphy was performed. The first step in surgery was the detection and dissection of lymph nodes identified as SLNs. Then, standard lymphadenectomy was performed, consisting in a limited dissection that included all lymph nodes from the obturator fossa and along the external iliac vein. Lymphatic tissue along the hypogastric artery was not systematically removed, except in the presence of SLNs.

Results

Mean patient age was 66 years (48–77); the mean serum prostate-specific antigen value was 10.6 ng/ml. In a high proportion of patients (21/27, 77.8%) an SLN was located along the initial centimetres of the hypogastric artery. The second most frequent site of SLNs was in the obturator fossa (11/27 patients, 40.7%), followed by the external iliac area (5/27 patients, 18.5%). Four patients had lymph node metastases, all in SLNs: two in the hypogastric area and two in the obturator fossa.

Conclusion

The SLN procedure revealed the individual variability in the lymphatic drainage of the prostate. The main site of SLNs was the hypogastric area, and two of the four metastatic nodes were located at this site. A limited standard pelvic lymphadenectomy, excluding the hypogastric lymph nodes, would have missed half of the lymph node metastases in this study. A radionuclide SLN procedure could assist in the correct staging of patients with early prostate cancer, especially when performing limited lymphadenectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Clark T, Parekh DJ, Coockson MS, Chang SS, Smith ER, Wells N, et al. Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer. J Urol 2003;169:145–8.

    Google Scholar 

  2. El-Galley RE, Keane TE, Petros JA, Sanders WH, Clarke HS, Cotsonis GA, et al. Evaluation of staging lymphadenectomy in prostate cancer. Urology 1998;52:663–7.

    Google Scholar 

  3. Bader P, Burkhard FC, Markwalder R, Studer UE. Is a limited lymph node dissection an adequate staging procedure for prostate cancer? J Urol 2002;168:514–8.

    Google Scholar 

  4. Burkhard FC, Bader P, Schneider E, Markwalder R, Studer UE. Reliability of preoperative values to determine the need for lymphadenectomy in patients with prostate cancer and meticulous lymph node dissection. Eur Urol 2002;42:84–92.

    Google Scholar 

  5. Heidenreich A, Varga Z, Von Knobloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 2002;167:1681–6.

    Google Scholar 

  6. Campbell SC, Klein EA, Levin HS, Piedmonte MR. Open pelvic lymph node dissection for prostate cancer: a reassessment. Urology 1995;46:352–5.

    Article  CAS  PubMed  Google Scholar 

  7. Haese A, Epstein JI, Huland H, Partin AW. Validation of a biopsy-based pathologic algorithm for predicting lymph node metastases in patients with clinically localized prostate carcinoma. Cancer 2002;95:1016–21.

    Google Scholar 

  8. Pisansky TM, Zincke H, Suman VJ, Bostwick DG, Earle JD, Oesterling JE. Correlation of pretherapy prostate cancer characteristics with histologic findings from pelvic lymphadenectomy specimens. Int J Radiat Oncol Biol Phys 1996;34:33–9.

    Google Scholar 

  9. Ghavamian R, Blute ML, Bergstralh EJ, Slezak J, Zincke H. Comparison of clinical non palpable PSA detected (cT1c) versus palpable (cT2) prostate cancers in patients undergoing radical retropubic prostatectomy. Urology 1999;54:105–10.

    Google Scholar 

  10. Harisinghani MG, Barentsz J, Hahn P, Deserno WM, Tabatabaei S, Hulsbergen van de Kaa C, et al. Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 2003;348:2491–9.

    Article  PubMed  Google Scholar 

  11. American Joint Committee on Cancer 2002. Cancer staging handbook: TNM classification of malignant tumors. 6th ed. Berlin Heidelberg New York: Springer; 2002.

  12. Sobin LH, Fleming ID. TNM classification of malignant tumors. 5th ed. 1997. Union Internationale contre le Cancer and the American Joint Committee on Cancer. Cancer 1997;80:1803–4.

    Google Scholar 

  13. Brossner C, Ringhofer H, Hernady T, Kuber W, Madersbacher S, Pycha A. Lymphatic drainage of prostatic transition and peripheral zones visualised on a three dimensional workstation. Urology 2001;57:389–93.

    Google Scholar 

  14. Brossner C, Ringhofer H, Schatzl G, Maderbacher S, Powischer G, Kuber W. Sacral distribution of prostatic lymph nodes visualized on spiral computed tomography with three-dimensional reconstruction. BJU Int 2002;89:44–7.

    Google Scholar 

  15. Raghavaiah NV, Jordan WP. Prostatic lymphography. J Urol 1979;121:178–81.

    Google Scholar 

  16. Zuckier LS, Finkelstein M, Kreutzer ER, Stone PL, Freed SZ, Bard RH, et al. Technetium-99m antinomy sulphide colloid lymphoscintigraphy of the prostate by direct transrectal injection. Med Nucl Commun 1990;11:589–96.

    Google Scholar 

  17. Wawroschek F, Vogt H, Weckermann D, Wagner T, Hamm M, Harzmann R. Radioisotope guided pelvic lymph node dissection for prostate cancer. J Urol 2001;166(5):1715–9.

    Google Scholar 

  18. Wawroschek F, Wagner T, Hamm M, Weckermann D, Vogt H, Märkl B, et al. The influence of serial sections, immunohistochemistry, and extension of pelvic lymph node dissection on the lymph node status in clinically localized prostate cancer. Eur Urol 2003;43(2):132–6.

    Google Scholar 

  19. Wawroschek F, Vogt H, Wengenmair H, Weckermann D, Hamm M, Keil M, et al. Prostate lymphoscintigraphy and radio-guided surgery for sentinel lymph node identification in prostate cancer. Technique and results of the first 350 cases. Urol Intl 2003;70(4):303–10.

    Google Scholar 

  20. 20. Takashima H, Egawa M, Imao T, Fukuda M, Yokoyama K, Namiki M. Validity of sentinel lymph node concept for patients with prostate cancer. J Urol 2004;171:2268–71.

    Google Scholar 

Download references

Acknowledgements

The authors thank Maryna B. Gabert for revision of the English text.

Author information

Authors and Affiliations

  1. Institut Paoli-Calmettes, Regional Cancer Center, Université de la Méditerranée, 232 Bd Sainte Marguerite, 13273, Marseille cedex 9, France

    Isabelle Brenot-Rossi & Jacques Pasquier

  2. Department of Urology, Hospital of the University of Marseille, CHU nord, Université de la Méditerranée, Marseille, France

    Cyril Bastide & Dominique Rossi

  3. Department of Pathology, Hospital of the University of Marseille, CHU nord, Université de la Méditerranée, Marseille, France

    Stephane Garcia

  4. Department of Radiology, Institut Paoli-Calmettes, Regional Cancer Center, Université de la Méditerranée, Marseille, France

    Stephane Dumas

  5. Department of Statistics, Institut Paoli-Calmettes, Regional Cancer Center, Université de la Méditerranée, Marseille, France

    Benjamin Esterni

Authors
  1. Isabelle Brenot-Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cyril Bastide
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephane Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephane Dumas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Benjamin Esterni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jacques Pasquier
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dominique Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Isabelle Brenot-Rossi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brenot-Rossi, I., Bastide, C., Garcia, S. 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 32, 635–640 (2005). https://doi.org/10.1007/s00259-004-1750-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-004-1750-3

Keywords

Search

Navigation