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.
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.
Article in French.
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