AIM: This study has aimed to evaluate the added value of SPECT-CT scan in the preoperative assessment of sentinel nodes of the presacral and pararectal regions localized outside the standard area of extended pelvic lymphadenectomy for the staging of the pelvis in prostate cancer.
SPECT-CT scan can serve as a guide for the excision of these nodes by lymphadenectomy by open surgery or laparoscopy.
MATERIAL AND METHODS: We evaluated 4 patients with prostate cancer presenting sentinel nodes in the pararectal and presacral regions on SPECT-CT scan performed in addition to lymphoscintigraphy. These patients underwent lymphadenectomy with robot-assisted laparoscopy together with prostatectomy. All of the excised lymph nodes were sent for histopathology study.
RESULTS: An average of 6 sentinel nodes per patient were found on SPECT-CT scan with a mean of 2 sentinel nodes in presacral/pararectal región. Lymphadenectomy including these areas was performed. Pararectal/presacral sentinel nodes of all patients depicted by SPECT-CT scan were tumor free on histopathology study. Sentinel nodes (no pararectal/presacral) were positive for malignancy in only one patient.
CONCLUSION: Preoperative SPECT-CT scan is a useful tool to localize the sentinel nodes in pararectal/presacral regions. It can be an anatomic guide for new modalities of laparoscopic surgery such as robot-assisted procedures that can access the pelvic areas visualized with SPECT-CT scan, making excision of these nodes possible.
Written by:
Chícharo de Freitas JR, KleinJan GH, van der Poel HG, van den Berg NS, Vegt E, Stokkel MP, Valdés Olmos RA. Are you the author?
Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Madrid, España; Department of Nuclear Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Holanda; Department of Radiology, Leiden University Medical Center, Leiden, Holanda; Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Holanda; Department of Nuclear Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Holanda.
Reference: Rev Esp Med Nucl Imagen Mol. 2015 Jan-Feb;34(1):19-23.
doi: 10.1016/j.remn.2014.09.001
PubMed Abstract
PMID: 25448419
Article in Spanish.