Brenot-Rossi Isabelle, Bastide Cyril, Garcia Stephane, Dumas Stephane, Esterni Benjamin, Pasquier Jacques, Rossi Dominique
Institut Paoli-Calmettes, Regional Cancer Center, Université de la Méditerranée, 232 Bd Sainte Marguerite, 13273, Marseille cedex 9, France.
Eur J Nucl Med Mol Imaging. 2005 Jun;32(6):635-40. doi: 10.1007/s00259-004-1750-3. Epub 2005 Mar 4.
The purpose of this study was to determine the potential role of the sentinel lymph node (SLN) procedure in limited lymph node dissection in patients with apparently localised prostate carcinoma.
In 27 patients with organ-confined prostate cancer, a single injection of 0.3 ml/30 MBq( 99m)Tc-rhenium sulphur colloid was injected transrectally into the peripheral zone of each lobe of the prostate (total 0.6 ml/60 MBq) under ultrasound guidance. Two hours after injection, scintigraphy was performed. The first step in surgery was the detection and dissection of lymph nodes identified as SLNs. Then, standard lymphadenectomy was performed, consisting in a limited dissection that included all lymph nodes from the obturator fossa and along the external iliac vein. Lymphatic tissue along the hypogastric artery was not systematically removed, except in the presence of SLNs.
Mean patient age was 66 years (48-77); the mean serum prostate-specific antigen value was 10.6 ng/ml. In a high proportion of patients (21/27, 77.8%) an SLN was located along the initial centimetres of the hypogastric artery. The second most frequent site of SLNs was in the obturator fossa (11/27 patients, 40.7%), followed by the external iliac area (5/27 patients, 18.5%). Four patients had lymph node metastases, all in SLNs: two in the hypogastric area and two in the obturator fossa.
The SLN procedure revealed the individual variability in the lymphatic drainage of the prostate. The main site of SLNs was the hypogastric area, and two of the four metastatic nodes were located at this site. A limited standard pelvic lymphadenectomy, excluding the hypogastric lymph nodes, would have missed half of the lymph node metastases in this study. A radionuclide SLN procedure could assist in the correct staging of patients with early prostate cancer, especially when performing limited lymphadenectomy.
本研究旨在确定前哨淋巴结（SLN）程序在明显局限性前列腺癌患者有限淋巴结清扫术中的潜在作用。
对27例器官局限性前列腺癌患者，在超声引导下经直肠向前列腺各叶外周区单次注射0.3 ml/30 MBq（99m）锝-硫化铼胶体（共0.6 ml/60 MBq）。注射后两小时进行闪烁扫描。手术的第一步是检测和切除被确定为前哨淋巴结的淋巴结。然后进行标准淋巴结清扫术，包括对闭孔窝和沿髂外静脉的所有淋巴结进行有限清扫。除存在前哨淋巴结外，沿腹下动脉的淋巴组织不进行系统性切除。
患者平均年龄为66岁（48 - 77岁）；血清前列腺特异性抗原平均 值为10.6 ng/ml。在高比例患者（21/27，77.8%）中，前哨淋巴结位于腹下动脉起始几厘米处。前哨淋巴结第二常见的部位是闭孔窝（11/27例患者，40.7%），其次是髂外区域（5/27例患者，18.5%）。4例患者有淋巴结转移，均在前哨淋巴结中：2例在腹下区域，2例在闭孔窝。
前哨淋巴结程序揭示了前列腺淋巴引流的个体差异。前哨淋巴结的主要部位是腹下区域，4个转移淋巴结中有2个位于该部位。在本研究中，不包括腹下淋巴结的有限标准盆腔淋巴结清扫术会遗漏一半的淋巴结转移。放射性核素前哨淋巴结程序可协助早期前列腺癌患者的正确分期，尤其是在进行有限淋巴结清扫术时。
