Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
To review contemporary imaging of pelvic lymph nodes in patients with prostate cancer as well as to analyze its significance and usefulness in clinical practice.
Because of poor sensitivity and specificity of computed tomography (CT) and MRI, new imaging modalities of lymph nodes in prostate cancer patients would be desirable. Three-dimensional reconstruction by fusion imaging between single-photon emission computed tomography after injection of Tc-99m colloid particles into the prostate and CT or MRI, has permitted a precise mapping of the primary lymphatic landing sites, or sentinel lymph nodes of the prostate. Intraoperative search for sentinel lymph nodes by γ-probe in open and laparoscopic surgery is possible.Routine use of choline PET/CT for initial staging of prostate cancer is not yet recommended. MRI combined with ultrasmall particles of iron oxide (USPIO) permits differentiation with a very high sensitivity between benign and malignant lymph nodes, independently of their size. Diffusion-weighted MRI combined with USPIO is a promising method for detecting lymph nodes metastases even in normal sized nodes. Both improved MRI methods are not yet introduced in routine clinical practice.
USPIO-MRI or/with diffusion-weighted MRI seems to be a promising noninvasive imaging modality for accurate imaging of lymph nodes in patients with prostate cancer.
Mattei A, Danuser H. Are you the author?
Reference: Curr Opin Urol. 2011 Feb 9. Epub ahead of print.