PATIENTS AND METHODS: A transrectal ultrasound-guided injection by 0.3mL/100MBq 99mTc-sulfur rhenium colloid in each prostatic lobe was performed the day before surgery. The detection was realized intraoperatively with a laparoscopic probe (Clerad(®) Gamma Sup) followed by extensive dissection. Counts of SLN were performed in vivo and confirmed ex vivo. The histological analysis was performed by hematoxyline-phloxine-safran staining and followed by immunochemistry if SLN is free.
RESULTS: Seventy patients with carcinoma of the prostate at intermediate or high risk of lymph node metastases were included. The intraoperative detection rate was 68/70 (97%). Fourteen patients had lymph node metastases, six only in SLN. The false negative rate was 2/14 (14%). The internal iliac region was the first metastatic site (40.9%). A metastatic sentinel node in common iliac region beyond the ureteral junction was present in 18.2%. A non-negligible sentinel metastatic region was the common iliac area (18.2%). Limited or standard lymph node dissection would have ignored respectively 72.7% and 59% of lymph node metastases.
CONCLUSION: The laparoscopy is adapted to a broad identification of SLN and targeted dissection of these lymph nodes significantly limited the risk of surgical extended dissection while maintaining the accuracy of the information.
Written by:
Rousseau T, Lacoste J, Pallardy A, Campion L, Bridji B, Mouaden A, Testard A, Aillet G, Le Coguic G, Potiron E, Curtet C, Kraeber-Bodéré F, Rousseau C. Are you the author?
Clinique urologique Nantes-Atlantis, avenue J-Cartier, 44800 Saint-Herblain, France.
Reference: Prog Urol. 2012 Jan;22(1):30-7.
doi: 10.1016/j.purol.2011.05.006
PubMed Abstract
PMID: 22196003
Article in French.
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