Prostate Cancer

The Sentinel Lymph Node Concept in Prostate Cancer - First Results of Gamma Probe-Guided Sentinel Lymph Node Identification
Friedhelm Wawroschek^a, Harry Vogt^b, Dorothea Weckermann^a, Theodor Wagner^c, Rolf Harzmann^a

Departments of
^aUrology,
^bNuclear Medicine and
^cPathology, Central Hospital, Augsburg, Germany

Address of Corresponding Author

Eur Urol 1999;36:595-600 (DOI: 10.1159/000020054)

  Key Words

• Prostatic neoplasms
• Lymph node excision
• Radionuclide imaging
• Lymph nodes
• Prostatectomy

  Abstract

Objective: The goal of this study was to show lymphatic drainage and to verify the validity of lymphoscintigraphy for the identification of the sentinel lymph node (SLN) in prostate cancer. Furthermore, the question is to be raised whether the standardized pelvic lymphadenectomy is a sufficient means for also detecting solitary micrometastases. Patients and Methods: Eleven patients with prostate cancer received a sonographically controlled, transrectal administration of a technetium-99m colloid injected directly into the prostate 1 day prior to pelvic lymphadenectomy. 20 min later the dynamic lymphoscintigraphy was carried out. During surgery, the SLNs were identified by using a gamma probe. The standard pelvic lymphadenectomy was performed after removal of the SLN. Results: In 3 of 4 patients with micrometastasis the spread of the tumor could exclusively be found in those nodes which had been identified as SLNs by means of scintigraphy by combining preoperative lymphoscintigraphy and intraoperative gamma probe detection. In 2 cases, the pathologically proved SLNs were situated at the anteromedial region of the internal iliac artery, thus being located outside of the standard pelvic lymphadenectomy area. In 1 patient, however, the micrometastasis was found beyond those nodes which had been identified as SLN intraoperatively. Conclusions: In the future, we expect the restriction of pelvic staging lymphadenectomy to scintigraphically proved SLN. The perioperative morbidity may be reduced by increasing the sensitivity of the detection of micrometastases. Our data confirm earlier perceptions, according to which even modified standardized pelvic lymphadenectomy is considered insufficient in terms of the detection of micrometastases.

Copyrightz1999S.KargerAG,Basel

  Author Contacts

Dr. Friedhelm Wawroschek
Department of Urology, Zentralklinikum Augsburg
Stenglinstrasse 2
D-86156 Augsburg (Germany)
Tel. +49 821 4002848, Fax +49 821 4004578

  Article Information

Accepted after revision: June 8, 1999
Number of Print Pages : 6
Number of Figures : 3, Number of Tables : 1, Number of References : 20