Staník M, Macík D, Čapák I, Marečková N, Lžíčařová E, Doležel J
Department of Urologic Oncology, Clinic of Surgical Oncology, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653, Brno, Czech Republic.
Department of Oncological and Experimental Pathology, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653, Brno, Czech Republic.
Int Urol Nephrol. 2018 Aug;50(8):1427-1433. doi: 10.1007/s11255-018-1903-0. Epub 2018 Jun 15.
Superparamagnetic nanoparticles of iron oxide (SPION) were shown to be non-inferior to standard radioisotope tracer in breast cancer and may be used as an alternative to identify sentinel lymph nodes (SLN). The aim of this study was to assess the feasibility of sentinel lymph node dissection (SLND) using SPION in prostate cancer and to evaluate its diagnostic accuracy.
Twenty patients with intermediate- and high-risk prostate cancer were prospectively enrolled in 2016. After intraprostatic injection of SPION, SLND using magnetometer was performed the following day. Extended pelvic lymph node dissection (ePLND) was added as a reference standard test. The diagnostic performance of the test were evaluated, as well as the rate of in vivo detected SLN. Surgical times of SLND and ePLND were compared using paired two-sample t test.
In total, 97 SLN were detected with median 5 (IQR 3-7) per patient. Non-diagnostic rate of the procedure was 5%. In total, 19 nodal metastases were found in 5 patients, of which 12 were located in SLN. The sensitivity per patient for the whole cohort was 80% and per node 56%. If only patients with at least one detected SLN were considered, the sensitivity per patient and per node reached 100 and 82%, respectively. A median of 20 LNs (IQR 18-22) were removed by subsequent ePLND. Surgical times of SLND and ePLND differed significantly, with medians of 17 and 39 min, respectively (p < 0.001).
SLND with SPION is feasible and safe in prostate cancer and the diagnostic accuracy is comparable to the published results of radioguided procedures. In open surgery, SPION may be used as an alternative tracer with its main advantage being the lack of radiation hazard.
超顺磁性氧化铁纳米颗粒（SPION）在乳腺癌中显示出不劣于标准放射性同位素示踪剂，可作为识别前哨淋巴结（SLN）的替代方法。本研究的目的是评估在前列腺癌中使用SPION进行前哨淋巴结清扫术（SLND）的可行性，并评估其诊断准确性。
2016年前瞻性纳入20例中高危前列腺癌患者。在前列腺内注射SPION后，次日使用磁力计进行SLND。增加扩大盆腔淋巴结清扫术（ePLND）作为参考标准检查。评估该检查的诊断性能以及体内检测到的SLN的比例。使用配对双样本t检验比较SLND和ePLND的手术时间。
总共检测到97个SLN，每位患者中位数为5个（四分位间距3 - 7）。该手术的非诊断率为5%。总共在5例患者中发现19处淋巴结转移，其中12处位于SLN。整个队列中每位患者的敏感性为80%，每个淋巴结为56%。如果仅考虑至少检测到一个SLN的患者，每位患者和每个淋巴结的敏感性分别达到100%和82%。随后的ePLND切除的淋巴结中位数为20个（四分位间距18 - 22）。SLND和ePLND的手术时间有显著差异，中位数分别为17分钟和39分钟（p < 0.001）。
在前列腺癌中，使用SPION进行SLND是可行且安全的，诊断准确性与已发表的放射性引导手术结果相当。在开放手术中，SPION可作为替代示踪剂，其主要优点是无辐射危害。
