244 RADIO-GUIDED SURGERY: OUR EXPERIENCE IN SENTINEL LYMPH NODE BIOPSY IN PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Staging (I)1 Apr 2013244 RADIO-GUIDED SURGERY: OUR EXPERIENCE IN SENTINEL LYMPH NODE BIOPSY IN PROSTATE CANCER Marco Grasso, Salvatore Blanco, Angelica Grasso, Giorgio Bovo, Andrea Crespi, and Maurizio Arosio Marco GrassoMarco Grasso Monza, Italy More articles by this author , Salvatore BlancoSalvatore Blanco Monza, Italy More articles by this author , Angelica GrassoAngelica Grasso Milan, Italy More articles by this author , Giorgio BovoGiorgio Bovo Monza, Italy More articles by this author , Andrea CrespiAndrea Crespi Monza, Italy More articles by this author , and Maurizio ArosioMaurizio Arosio Monza, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1624AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The standard surgical treatment of PCa consists of radical prostatectomy (RP). The gold standard for N-staging is operative extended lymphadenectomy (eLND) that includes removal of the nodes overlying the external iliac artery and vein, the nodes within the obturator fossa located cranially and caudally to the obturator nerve, and the nodes medial and lateral to the internal ileac artery. Lymphadenectomy with removal of the sentinel lymph node is now evolving towards the concept of radioguided surgery as an instrument for the removal of the lymph nodes of primary drainage. METHODS From October 2011 to September 2012 laparotomic SLN dissection was performed in 43 pts during radical prostatectomy. Twenty hours before surgery, 240 MBq of 99mTc Nanocoll® in 0.8 ml of physiological solution (divided into 4 injections of 60 MBq) were injected into the prostate gland under transrectal ultrasound guidance. Intraoperatively, all LNs detected by gamma-probe with an activity significantly higher than background (4 cps) were removed and classified as SLNs. We have evaluated radioactive exposure rates as well. RESULTS The intraoperative detection of SLNs occurred in all 43 pts, while the scintigraphic localization was observed in 42/43 pts. In 1/43 pt the abnormal bladder activity probably masked the SLN, that was however detected intraoperatively by gamma-probe. In 16 pts SLNs were exclusively outside the obturator fossa while in 14 pts SLNs were both inside and outside obturator fossa. A total of 77 SLNs were found, at histopathological analysis 8/77 SLNs resulted positive for metastases (5/43 pts): 3/4 were in the obturator fossa while the remaining SLN was in the internal iliac chain, that is not a routinely sampled region. CONCLUSIONS Our preliminary data confirm the feasibility and the safety of SLN biopsy in nodal staging of PCa. The intraoperatively SLN detection rate resulted 100%. In 4 cases (10%) a micrometastases was found outside of obturator fossa in a not routinely sampled site. The technique has proved safe, the risk of exposure for all operators is contained and does not warrant classification as “staff exposed” involved in any of the categories that are not already exposed to other sources of risk, particular attention should be given to personal contamination, special attention should be paid to the management of contaminated waste. Radioguided surgery can enable us find positive lymph nodes even in usual sites and in patients with low PSA. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e100-e101 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Grasso Monza, Italy More articles by this author Salvatore Blanco Monza, Italy More articles by this author Angelica Grasso Milan, Italy More articles by this author Giorgio Bovo Monza, Italy More articles by this author Andrea Crespi Monza, Italy More articles by this author Maurizio Arosio Monza, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...