Indocyanine Green guided pelvic lymph node dissection. An efficient technique to classify the lymph node status of patients with prostate cancer who underwent radical prostatectomy.

To evaluate the effectiveness of ICG-guided pelvic lymph node dissection for optimal staging of patients with prostate cancer and to analyze whether the technique can replace extended Pelvic Lymph node Dissection (ePLND).

25 mg ICG in 5 ml sterile water solution was transperineally injected. PLND was started with the ICG-stained nodes, followed by the ePLND. Primary outcome measures were sensitivity, specificity, predictive value and likelihood ratio of a negative test of the ICG-guided PLND.

eighty four patients with a median age of 63.55 years and a median PSA of 8.48 were included. Of them 60.7% were intermediate- and 25% high- or very high risk. A median of 7 ICG-stained nodes per patient was detected (2-18), with a median of 22 nodes excised during the ePLND. LN metastasis were identified in 25 patients, 23 of them had been properly classified by the ICG guided PLND. Most frequent location of ICG-stained nodes was the proximal internal iliac artery, followed by the fossa of Marcille. The negative predictive value (NPV) was 96.7%, and the likelihood ratio of negative test (LR(-)) was 8%. Overall, 1856 were removed, and 603 were ICG-stained-LN. Pathological examination revealed 82 metastatic nodes, 60% of them were ICG-stained-LN. The NPV was 97.4%, but the LR(-) was 58.5%.

ICG-guided PLND staged correctly 97% of patients, however, according to our data, it cannot replace the ePLND. Nevertheless, its high NPV could potentially avoid an ePLND if we had an accurate intraoperative lymph fluorescent analysis.

The Journal of urology. 2016 May 25 [Epub ahead of print]

Miguel Ramírez-Backhaus, Alejandra Mira Moreno, Alvaro Gómez Ferrer, Ana Calatrava Fons, Juan Casanova, Eduardo Solsona Narbón, Isabel María Ortiz Rodríguez, José Rubio Briones

Department of Urology. Valencian Oncology Institute. FIVO. Electronic address: ., Department of Urology. Valencian Oncology Institute. FIVO., Department of Urology. Valencian Oncology Institute. FIVO., Pathology Department FIVO., Department of Urology. Valencian Oncology Institute. FIVO., Department of Urology. Valencian Oncology Institute. FIVO., Mathematics Department. University of Almería., Department of Urology. Valencian Oncology Institute. FIVO.