Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands.
Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, Netherlands.
Nat Rev Urol. 2019 Mar;16(3):159-171. doi: 10.1038/s41585-018-0140-8.
One of the challenges for the surgical management of prostate cancer is the lymphatic spread of metastases. Lymph node metastases vary in size (micrometastases (<2 mm) or macrometastases (>2 mm)), and their interactions with the lymphatic environment differ (whether they are hypoxic or connected to blood flow). Thus, devising a universal imaging system and an image-guided surgical approach that supports the resection of all affected lymph nodes is difficult. Two complementary approaches to identifying affected lymph nodes have been described as alternatives to performing a traditional pelvic lymph node dissection: lymphatic mapping using radioguidance (the most widely applied modality), fluorescence guidance, integrated hybrid radioguidance and fluorescence guidance or magnetic guidance; and surgery guided by radiolabelled prostate-specific membrane antigen. Careful patient selection using preoperative imaging seems to be a crucial aspect in determining whether one of the individual image-guided surgery procedures alone would be optimal or whether a combination would be considered to be the most desirable course of action. The successful implementation and dissemination of both lymph-node-targeted and disease-targeted procedures are very much reliant on ongoing technical developments in the field and their standardization and interpretation. However, when these innovative surgical procedures are fully refined, evaluation of their influence on oncological outcome is imperative.
前列腺癌手术治疗的挑战之一是淋巴结转移的淋巴扩散。淋巴结转移的大小不同（微转移（<2 毫米）或巨转移（>2 毫米）），它们与淋巴环境的相互作用也不同（是否缺氧或与血流相连）。因此，设计一种通用的成像系统和图像引导手术方法来支持切除所有受影响的淋巴结是很困难的。已经描述了两种互补的方法来识别受影响的淋巴结，作为传统盆腔淋巴结清扫术的替代方法：放射性引导的淋巴作图（最广泛应用的模式）、荧光引导、放射性引导和荧光引导的集成混合或磁引导；以及放射性标记的前列腺特异性膜抗原引导的手术。使用术前成像进行仔细的患者选择似乎是确定单独使用一种图像引导手术程序是否是最佳选择，还是考虑联合使用是最理想的方法的关键方面。淋巴结靶向和疾病靶向手术的成功实施和推广在很大程度上依赖于该领域的持续技术发展及其标准化和解释。然而，当这些创新的手术程序完全完善后，评估它们对肿瘤学结果的影响是至关重要的。
