You have accessJournal of UrologyProstate Cancer: Staging II1 Apr 2016MP79-18 EX-VIVO EVALUATION OF INTRAPROSTATIC TRACER DISTRIBUTION OF TARGETED VERSUS TEMPLATE PERINEAL INJECTION OF FREE INDOCYANINE GREEN FOR FLUORESCENCE TARGETED PELVIC LYMPH NODE DISSECTION (F-T PLND) IN PROSTATE CANCER Christine Englberger, Tobias Schätz, Thomas Kunit, Martin Drerup, Matthias Meissnitzer, Rosemarie Forstner, Esra Foditsch, Peter Törzsök, Martina Hager, Günter Janetschek, Karl-Dietrich Sievert, and Stephan Hruby Christine EnglbergerChristine Englberger More articles by this author , Tobias SchätzTobias Schätz More articles by this author , Thomas KunitThomas Kunit More articles by this author , Martin DrerupMartin Drerup More articles by this author , Matthias MeissnitzerMatthias Meissnitzer More articles by this author , Rosemarie ForstnerRosemarie Forstner More articles by this author , Esra FoditschEsra Foditsch More articles by this author , Peter TörzsökPeter Törzsök More articles by this author , Martina HagerMartina Hager More articles by this author , Günter JanetschekGünter Janetschek More articles by this author , Karl-Dietrich SievertKarl-Dietrich Sievert More articles by this author , and Stephan HrubyStephan Hruby More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In recent works, we described the evolution and outcome of ft-PLND utilizing Indocyan Green (ICG) in Prostate cancer. The purpose of this study was to evaluate how free ICG dissolves throughout the prostate and if a TRUS/MRI-targeted injection could add more precision. METHODS We evaluated 8 targeted and 7 template- injected prostate specimens of patients in whom a high or intermediate risk prostate cancer was detected. All patients underwent transperitoneal laparoscopic prostatectomy and f-t PLND using a Storz camera system. In patients, where a distinct index tumor was detected by TRUS/MRI Fusion biopsy 1cc free ICG/ 1 cc cancer volume was injected perineally into and around the tumor by the same means at the beginning of the operation. In the other cases ICG was injected TRUS-guided perineally into the peripheral zone into three definded templates (2.5 cc/ 3 portions (Base/Mid/Apex )/ each lobe). After removal of all ICG visualized lymph node templates, a routine super-extended PLND was carried out as control. From all lymph nodes 250 µm paraffin sections were prepared and analyzed by immunohistochemistry. In addition, we analyzed the intraprostatic tracer distribution and concentration of the locally injected ICG to by using a fluorescence imaging system ex vivo. RESULTS In total, 125 sections of 15 prostates have been analyzed. A fluorescence signal in the different sections of the prostate could be visualized in every patient. Free ICG stayed at the site of injection and did not dissolve completely throughout the prostate. The average diameter of fluorescence activity was 8 mm in the targeted vs. 11 mm in the template injected group. F-activity in the index tumor was found in all patients in the targeted group vs. 4 patients (57 %) in the template group. Additional tumor was not covered in 53 % (4 targeted vs 3 template). The average number of F-visualized Lymphnodes was 15 in the template group vs 8,2 LN in the targeted group. CONCLUSIONS Ex-vivo fluorescence imaging of the prostate could show that free ICG stays at the injection side and does not dissolve throughout the prostate. Although a targeted injection into and around the area of the tumor allows for accurate studying the drainage pattern of the index lesion, it could also miss some tumor, which is maybe not visualized by MRI. Therefore a combined approach seems to be the most promising method and should be advised to identify the complete drainage pattern of the all tumor tissue of the prostate. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1041 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Christine Englberger More articles by this author Tobias Schätz More articles by this author Thomas Kunit More articles by this author Martin Drerup More articles by this author Matthias Meissnitzer More articles by this author Rosemarie Forstner More articles by this author Esra Foditsch More articles by this author Peter Törzsök More articles by this author Martina Hager More articles by this author Günter Janetschek More articles by this author Karl-Dietrich Sievert More articles by this author Stephan Hruby More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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