Małkiewicz Bartosz, Bugla Błażej, Czarnecki Maciej, Karwacki Jakub, Długosz Paulina, Gurwin Adam, Kiełb Paweł, Lemiński Artur, Krajewski Wojciech, Jędrzejuk Diana, Bolanowski Marek, Hałoń Agnieszka, Szydełko Tomasz
University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland.
Department of Urology and Urological Oncology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland.
Cancers (Basel). 2022 Oct 13;14(20):5012. doi: 10.3390/cancers14205012.
In many malignancies, sentinel lymph node dissection (SLND) is being used as a nodal staging tool. We prospectively evaluated the diagnostic value of radio-guided sentinel lymph node (SLN) detection in patients with prostate cancer (PCa). This study aimed to investigate the reliability of the radio-guided SLN detection technique for perioperative localization of LNs metastases as well as to map lymphatic drainage patterns of the prostate. Forty-three patients with intermediate- or high-risk cN0cM0 PCa at conventional imaging underwent radical prostatectomy with modified-extended pelvic lymph node dissection (mePLND). A day before the planned surgery, a Tc-99m nanocolloid was injected into the prostate under the control of transrectal ultrasonography (TRUS). Preoperative single-photon emission computed tomography (SPECT-CT) imaging and intraoperative gamma-probe were used to identify SLNs. All positive lesions were excised, followed by mePLND. The excised lymph nodes (LNs) were then submitted for histopathological examination, which was used as a reference for the calculation of diagnostic parameters of the SLN technique for SPECT-CT and the intraoperative gamma-probe. In total, 119 SLNs were detected preoperatively (SPECT-CT) and 118 intraoperatively (gamma-probe). The study revealed that both SLN detection techniques showed a sensitivity of 90% and a specificity of 6.06%. The negative predictive value (NPV) was 66.67%. SLN technique would have correctly staged nine of 10 patients, which is the same result as in the case of limited LND. However, it allowed the removal of all metastatic nodes only in four of them. SLND would have comprised 69.7% of preoperatively detected LNs, and removed 13 out of 19 positive LNs (68.42%), respectively. Radio-guided SLND has a low diagnostic rate and is a poor staging tool. ePLND remains the gold standard in nodal metastases assessment in PCa. Our study indicates that lymphatic drainage of the prostate and actual metastasis routes may vary significantly.
在许多恶性肿瘤中，前哨淋巴结清扫术（SLND）正被用作一种淋巴结分期工具。我们前瞻性地评估了放射性引导前哨淋巴结（SLN）检测在前列腺癌（PCa）患者中的诊断价值。本研究旨在调查放射性引导SLN检测技术用于围手术期定位淋巴结转移灶的可靠性以及绘制前列腺的淋巴引流模式。43例在传统影像学检查中为中高危cN0cM0期PCa的患者接受了根治性前列腺切除术及改良扩大盆腔淋巴结清扫术（mePLND）。在计划手术前一天，在经直肠超声（TRUS）引导下将99mTc纳米胶体注入前列腺。术前使用单光子发射计算机断层扫描（SPECT-CT）成像和术中γ探测器来识别SLN。切除所有阳性病灶，随后进行mePLND。然后将切除的淋巴结送检进行组织病理学检查，其用作计算SPECT-CT和术中γ探测器的SLN技术诊断参数的参考。术前（SPECT-CT）共检测到119个SLN，术中（γ探测器）检测到118个。研究表明，两种SLN检测技术的灵敏度均为90%，特异性为6.06%。阴性预测值（NPV）为66.67%。SLN技术可使10例患者中的9例分期正确，这与有限淋巴结清扫术的结果相同。然而，仅在其中4例患者中它能切除所有转移淋巴结。SLND将分别包括术前检测到的淋巴结的69.7%，并切除19个阳性淋巴结中的13个（68.42%）。放射性引导SLND的诊断率较低，是一种较差的分期工具。扩大盆腔淋巴结清扫术（ePLND）仍然是PCa淋巴结转移评估的金标准。我们的研究表明，前列腺的淋巴引流和实际转移途径可能有显著差异。
Zotero 插件
