Sentinel lymph node dissection in prostate cancer

A technique known as sentinel lymph node dissection (SLND) has replaced extended lymphadenectomy for nodal staging in several types of solid tumor cancers.

Holl et al. have now published data on 2,020 patients who have received a SNLD (either alone or in combination with standard pelvic lymph node dissection or extended lymphadenectomy) after radical retropubic prostatectomy.

The procedure takes place over two days. On the first day the patient receives an intraprostatic injection of a nanocolloidal formulation of radioactive technectium-99m. Two hours later, static scans of the pelvis are performed to get information about the number and location of radioactive lymph nodes. The next day, during surgery, the radioactive nodes are excised and sent separately to the pathology laboratory for histologic analysis.

The results of this single-institution study over the past 10 years are as follows:

  • Lymph nodes positive for prostate cancer were found in 337/2,020 patients (16.7 percent).
  • The scintigraphic detection rate was 97.6 percent and the intraoperative detection rate was 98 percent.
  • For 187 lymph node-positive men who had either standard or extended lymphadenectomy in addition to SLND,  false negative findings occurred in 11/187 patients (6 patients).

It would seen that, as the authors claim,  SLND  is a reliable procedure for nodal staging in patients with prostate cancer.

Whether this technique can actually replace st6andard and extended pelvic lymph node dissection as a mean to detect positive lymph nodes in intermediate and high risk patients prior to definitive treatment is a more complex question. It appears that the technique has high potential as a means to select appropriate therapy for individual patients, and it is non-invasive. Given that the rate of positive findings in 2,020 patients was only 16.7 percent, one would, however, probably want to be selective about exactly which patients really needed such a technique in the community setting.

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