Miki Jun, Yanagisawa Takafumi, Tsuzuki Shunsuke, Mori Keiichiro, Urabe Fumihiko, Kayano Sotaro, Yorozu Takashi, Sato Shun, Kimura Takahiro, Takahashi Hiroyuki, Kishimoto Koichi, Egawa Shin
Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan.
Department of Pathology, Jikei University School of Medicine, Tokyo, Japan.
Prostate. 2018 May;78(6):419-425. doi: 10.1002/pros.23486. Epub 2018 Jan 25.
Although sentinel lymph node in prostate has been generating renewed interest, its significance remains controversial due to inadequate evidence.
We reviewed a prospective cohort of 50 consecutive patients with intermediate- to high-risk localized prostate cancer who had undergone laparoscopic radical prostatectomy. Sentinel lymph node biopsy by fluorescence detection using intraoperative imaging with indocyanine green and backup extended pelvic lymph node dissection were conducted prior to prostatectomy. Intraoperative and pathological findings were elaborated and compared for confirmation.
Sentinel lymph nodes were successfully identified in 47 patients (94%). A median of four sentinel lymph nodes was detected per patient. Lymph node metastasis was confirmed in six patients (12%), all of whom had positive sentinel lymph nodes. Three typical pathways of lymphatic drainage related to sentinel lymph nodes from the prostate were recognized. Ninety-one percent of the positive sentinel lymph nodes (10/11) were located at two predominant sites along these characteristic lymphatic pathways. One site was the junctional nodes, located at the junction between internal and external iliac vessels. The other was the distal internal iliac nodes, located along the inferior vesical artery.
Over 90% of positive sentinel lymph nodes were identified at two predominant sites. Priority should be given to the removal of these sentinel lymph nodes, which are located closer to the prostate, in pelvic lymph node dissection. Particular attention should be paid to identifying these nodes to reduce the possibility of overlooking lymph node metastasis.
尽管前列腺前哨淋巴结一直备受关注，但其意义因证据不足仍存在争议。
我们回顾性分析了50例连续接受腹腔镜根治性前列腺切除术的中高危局限性前列腺癌患者的前瞻性队列。在前列腺切除术前，采用吲哚菁绿术中成像荧光检测法进行前哨淋巴结活检，并辅助进行扩大盆腔淋巴结清扫术。详细阐述并比较术中及病理结果以进行确认。
47例患者（94%）成功识别出前哨淋巴结。每位患者检测到的前哨淋巴结中位数为4个。6例患者（12%）确诊有淋巴结转移，所有这些患者的前哨淋巴结均为阳性。识别出了与前列腺前哨淋巴结相关的三种典型淋巴引流途径。91%的阳性前哨淋巴结（10/11）位于沿这些特征性淋巴途径的两个主要部位。一个部位是交界淋巴结，位于髂内和髂外血管的交界处。另一个是髂内远端淋巴结，位于膀胱下动脉沿线。
超过90%的阳性前哨淋巴结位于两个主要部位。在盆腔淋巴结清扫术中，应优先切除这些距离前列腺较近的前哨淋巴结。应特别注意识别这些淋巴结，以降低漏诊淋巴结转移的可能性。
