Mapping of pelvic lymph node metastases in prostate cancer
- PMID: 22795517
- DOI: 10.1016/j.eururo.2012.06.057
Mapping of pelvic lymph node metastases in prostate cancer
Abstract
Background: Opinions about the optimal lymph node dissection (LND) template in prostate cancer differ. Drainage and dissemination patterns are not necessarily identical.
Objective: To present a precise overview of the lymphatic drainage pattern and to correlate those findings with dissemination patterns. We also investigated the relationship between the number of positive lymph nodes (LN+) and resected lymph nodes (LNs) per region.
Design, setting, and participants: Seventy-four patients with localized prostate adenocarcinoma were prospectively enrolled. Patients did not show suspect LNs on computed tomography scan and had an LN involvement risk of ≥ 10% but ≤ 35% (Partin tables) or a cT3 tumor.
Intervention: After intraprostatic technetium-99m nanocolloid injection, patients underwent planar scintigraphy and single-photon emission computed tomography imaging. Then surgery was performed, starting with a sentinel node (SN) procedure and a superextended lymphadenectomy followed by radical prostatectomy.
Outcome measurements and statistical analysis: Distribution of scintigraphically detected SNs and removed SNs per region were registered. The number of LN+, as well as the percentage LN+ of the total number of removed LNs per region, was demonstrated in combining data of all patients. The impact of the extent of LND on N-staging and on the number of LN+ removed was calculated.
Results and limitations: A total of 470 SNs were scintigraphically detected (median: 6; interquartile range [IQR]: 3-9), of which 371 SNs were removed (median: 4; IQR: 2.25-6). In total, 91 LN+ (median: 2; IQR: 1-3) were found in 34 of 74 patients. The predominant site for LN+ was the internal iliac region. An extended LND (eLND) would have correctly staged 32 of 34 patients but would have adequately removed all LN+ in only 26 of 34 patients. When adding the presacral region, these numbers increased to 33 of 34 and 30 of 34 patients, respectively.
Conclusions: Standard eLND would have correctly staged the majority of LN+ patients, but 13% of the LN+ would have been missed. Adding the presacral LNs to the template should be considered to obtain a minimal template with maximal gain. NOTE: This manuscript was invited based on the 2011 European Association of Urology meeting in Vienna.
Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Comment in
-
Pelvic lymph node dissection in prostate cancer: the mystery is taking shape.Eur Urol. 2013 Mar;63(3):459-61. doi: 10.1016/j.eururo.2012.08.029. Epub 2012 Aug 25. Eur Urol. 2013. PMID: 22939386 No abstract available.
-
Reply to Henk G. van der Poel, Tessa Buckle and Renato Valdes Olmos' letter to the editor re: Steven Joniau, Laura Van den Bergh, Evelyne Lerut, et al. Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2012.06.057.Eur Urol. 2013 Feb;63(2):e21-2. doi: 10.1016/j.eururo.2012.10.046. Epub 2012 Nov 5. Eur Urol. 2013. PMID: 23149147 No abstract available.
-
Re: Steven Joniau, Laura Van den Bergh, Evelyne Lerut, et al. Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2012.06.057.Eur Urol. 2013 Feb;63(2):e20. doi: 10.1016/j.eururo.2012.10.045. Epub 2012 Nov 2. Eur Urol. 2013. PMID: 23153744 No abstract available.
-
Re: Steven Joniau, Laura Van den Bergh, Evelyne Lerut, et al. Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol 2013;63:450-8.Eur Urol. 2013 Sep;64(3):e55-6. doi: 10.1016/j.eururo.2013.05.038. Epub 2013 May 29. Eur Urol. 2013. PMID: 23746720 No abstract available.
-
Reply to Kwang Hyun Kim and Koon Ho Rha's letter to the editor Re: Steven Joniau, Laura Van den Bergh, Evelyne Lerut, et al. Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol 2013;63:450-8.Eur Urol. 2013 Sep;64(3):e57-8. doi: 10.1016/j.eururo.2013.05.039. Epub 2013 May 29. Eur Urol. 2013. PMID: 23769590 No abstract available.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources