Prostate lymphoscintigraphy and radio-guided surgery for sentinel lymph node identification in prostate cancer - Technique and results of the first 350 cases

Introduction: Having in mind the promising results of
lymphoscintigraphy and intraoperative gamma probe application for
the detection of sentinel lymph nodes (SLN) in malignant melanoma,
breast and penis cancer, we tried to identify the SLN in prostate
cancer by applying a comparable technique. Materials and Method.
350 patients with prostate cancer were examined after providing
informed consent. The day before pelvic lymphadenectomy
technetium-99m nanocolloid was transrectally injected into the
prostate under ultrasound guidance. A single central application
was done per prostate lobe in most cases. Activity attained 90400
MBq, and the total injected volume was about 2-3 ml. Hereafter,
lymphoscintigraphy was carried out. Those lymph nodes having been
identified as SLN by means of gamma probe detection and
lymphoscintigraphy were removed intraoperatively. Later, most of
the cases had different types of pelvic lymphadenectomy. SLN
received serial sections and immunohistochemistry, non-SLN step
sections. Results: 335 patients showed at least 1 SLN in
lymphoscintigraphy. 24.7% had lymph node metastases. In 2 patients,
metastases in non-SLN were found without at least one SLN being
affected (false-negative patient). Conclusion:Our experience
suggests that the SLN identification is not only feasible in breast
cancer and malignant melanoma, but also in prostate cancer with a
comparable technique. Copyright (C) 2003 S. Karger AG, Basel.