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Technology Insight: radioguided sentinel lymph node dissection in the staging of prostate cancer

Nature Clinical Practice Urology volume 3, pages 602–610 (2006)Cite this article

An Erratum to this article was published on 01 December 2006

Abstract

Pelvic lymph node dissection is the only reliable method of staging for clinically localized prostate cancer. Despite the obvious prognostic advantages conferred by accurate staging, pelvic lymph node dissection is associated with significant morbidity and prolonged operative time. A substantial decrease in the sensitivity to lymph node metastasis occurs by simple reduction of the dissection area to the obturator fossa. Radioguided sentinel lymph node dissection provides accurate staging despite use of a minimal-area dissection template. Results from studies in prostate cancer indicate that this method has a high sensitivity for very early detection of lymphatic spread. A substantial number of the detected metastases are of a small size, solitary and widely distributed throughout the pelvic lymph nodes. These features make metastases undetectable by preoperative imaging modalities, and by the current, standard method of lymph node dissection limited to the obturator fossa.

Key Points

  • Radioguided sentinel lymph node (SLN) dissection is a reliable method of staging for clinically localized prostate cancer

  • Clinical application of SLN staging in prostate cancer is associated with reduced surgical complexity and a reduced complication rate compared with extended lymph node dissection, while retaining maximal sensitivity for detection of lymphatic metastases

  • SLN staging is not affected by the size of a metastatic lesion and, therefore, detects even micrometastases effectively

  • Awareness of prostate lymph drainage anatomy, and technical considerations related to radiopharmaceutical properties and detection technique, are of pivotal importance for the successful clinical application of prostate cancer SLN staging

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Figure 1: Schematic illustration of the sentinel lymph node concept.
Figure 2: Average percentage uptake of radiation by organs and tissues following intraprostatic application of a radiopharmaceutical.19
Figure 3: Preoperative planar scintigraphy in the detection of sentinel lymph nodes.
Figure 4: Regional distribution of sentinel lymph nodes detected on preoperative SPECT-CT and intraoperatively.
Figure 5: Scanning the pelvic sidewalls with a laparoscopic gamma probe.

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Authors and Affiliations

  1. Fellow in Endourology and Laparoscopic Surgery, Department of Urology, Elisabethinen Hospital, Linz, Austria

    Avi Beri

  2. Professor and Chairman of the Department of Urology, Elisabethinen Hospital, Linz, Austria

    Günter Janetschek

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  1. Avi Beri
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  2. Günter Janetschek
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Correspondence to Avi Beri.

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Beri, A., Janetschek, G. Technology Insight: radioguided sentinel lymph node dissection in the staging of prostate cancer. Nat Rev Urol 3, 602–610 (2006). https://doi.org/10.1038/ncpuro0625

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