Skip to main content
SpringerLink
Log in

Sentinel lymph node dissection combined with meticulous histology increases the detection rate of nodal metastases in prostate cancer

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate benefits of sentinel lymph node (SLN) biopsy for staging accuracy in prostate cancer. Extended pelvic lymph node dissection (ePLND) is a preferred staging tool; however, it may underestimate the incidence of nodal involvement.

Methods

Eighty patients with estimated risk of lymphadenopathy above 5 % based on Briganti nomogram had Tc-99m-labeled nanocolloid injected into the prostate. Planar lymphoscintigraphy and single-photon emission computed tomography/CT were performed to localize SLNs. Radioguided SLN dissection was followed by backup ePLND comprising external iliac, obturator and internal iliac regions. All SLNs were serially sectioned every 150 μm and examined using hematoxylin and eosin; immunohistochemical staining was applied every 300 μm.

Results

A total of 335 SLNs were detected, and 17 % were located outside ePLND template. Nodal metastases were diagnosed in 32 patients (40 %). Without radioguided SLN localization, solitary metastases posteriorly to the branches of the internal ilaic vessels, in pararectal and common iliac regions would not have been removed in five of 32 patients (16 %). Using standard histology protocol, we would have diagnosed metastases in 23 patients with median size of 2.8 mm. Serial sectioning of SLN and immunohistochemistry led to the detection of metastases in additional nine patients (28 %) with median size of 0.2 mm.

Conclusion

ePLND comprised 83 % of SLNs, at least one SLN laid outside its template in 28 % of patients. ePLND and SLN dissection combined with nodal serial sectioning and immunohistochemistry increased the detection rate of nodal metastases by 68 % in comparison with ePLND alone and standard histology protocol.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

CT:

Computed tomography

ePLND:

Extended pelvic lymph node dissection

ICG:

Indocyanine green

IQR:

Interquartile range

ITC:

Isolated tumor cells

H&E:

Hematoxylin and eosin

PSA:

Prostate-specific antigen

SLN:

Sentinel lymph node

SPECT:

Single-photon emission computed tomography

References

  1. Cheng L, Zincke H, Blute ML et al (2001) Risk of prostate carcinoma death in patients with lymph node metastasis. Cancer 91:66–73

    Article  CAS  PubMed  Google Scholar 

  2. Heidenreich A, Bellmunt J, Bolla M et al (2011) European Association of Urology. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localized disease. Eur Urol 59:61–71

    Article  PubMed  Google Scholar 

  3. Briganti A, Blute ML, Eastham JH et al (2009) Pelvic lymph node dissection in prostate cancer. Eur Urol 55:1251–1265

    Article  PubMed  Google Scholar 

  4. Abdollah F, Sun M, Thuret R et al (2010) Decreasing rate and extent of lymph node staging in patients undergoing radical prostatectomy may undermine the rate of diagnosis of lymph node metastases in prostate cancer. Eur Urol 58:882–892

    Article  PubMed  Google Scholar 

  5. Wawroschek F, Wagner T, Hamm M et al (2003) The influence of serial sections, immunohistochemistry and extension of pelvic lymph node dissection on the lymph node status in clinically localized prostate cancer. Eur Urol 43:132–137

    Article  PubMed  Google Scholar 

  6. Briganti A, Karakiewicz PI, Chun FK et al (2007) Percentage of positive biopsy cores can improve the ability to predict lymph node invasion in patients undergoing radical prostatectomy and extended pelvic lymph node dissection. Eur Urol 51:1573–1581

    Article  PubMed  Google Scholar 

  7. Holl G, Dorn R, Wengenmair H et al (2009) Validation of sentinel lymph node dissection in prostate cancer: experience in more than 2,000 patients. Eur J Nucl Med Mol Imaging 36:1377–1382

    Article  CAS  PubMed  Google Scholar 

  8. Jeschke S, Beri A, Grüll M et al (2008) Laparoscopic radioisotope-guided sentinel lymph node dissection in staging of prostate cancer. Eur Urol 58:126–133

    Article  Google Scholar 

  9. Joniau S, Van den Bergh L, Lerut E et al (2013) Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol 63:450–458

    Article  PubMed  Google Scholar 

  10. Rousseau C, Rousseau T, Bridji B et al (2012) Laparoscopic sentinel lymph node (SLN) versus extensive pelvic dissection for clinically localized prostate carcinoma. Eur J Nucl Med Mol Imaging 39:291–299

    Article  PubMed  Google Scholar 

  11. Schumacher MC, Burkhard FC, Thalmann GN et al (2008) Good outcome for patients with few lymph node metastases after radical retropubic prostatectomy. Eur Urol 54:344–352

    Article  PubMed  Google Scholar 

  12. Mattei A, Fuechsel FG, Bhatta Dhar N et al (2008) The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol 53:118–125

    Article  PubMed  Google Scholar 

  13. Van der Poel HG, Buckle T, Brouwer OR et al (2011) Intraoperative laparoscopic fluorescence guidance to the sentinel lymph node in prostate cancer patients: clinical proof of concept of an integrated functional imaging approach using a multimodal tracer. Eur Urol 60:826–833

    Article  PubMed  Google Scholar 

  14. Jeschke S, Lusuardi L, Myatt A et al (2012) Visualisation of the lymph node pathway in real time by laparoscopic radioisotope and fluorescence-guided sentinel lymph node dissection in prostate cancer staging. Urology 80:1080–1087

    Article  PubMed  Google Scholar 

  15. Heidenreich A, Varga Z, Von Knobloch R (2002) Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 167:1681–1686

    Article  PubMed  Google Scholar 

  16. Golimbu M, Morales P, Al-Askari S et al (1979) Extended pelvic lymphadenectomy for prostatic cancer. J Urol 121:617–620

    CAS  PubMed  Google Scholar 

  17. Fukuda M, Egawa M, Imao T et al (2007) Detection of sentinel node micrometastasis by step section and immunohistochemistry in patients with prostate cancer. J Urol 177:1313–1317

    Article  PubMed  Google Scholar 

  18. Briganti A, Larcher A, Abdollah F et al (2012) Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 61:480–487

    Article  PubMed  Google Scholar 

  19. De Boer M, van Deurzen CH, van Dijck JA et al (2009) Micrometastases or isolated tumor cells and the outcome of breast cancer. N Engl J Med 361:653–663

    Article  PubMed  Google Scholar 

  20. Pagliarulo V, Hawes D, Brands FH et al (2006) Detection of occult lymph node metastases in locally advanced node-negative prostate cancer. J Clin Oncol 24:2735–2742

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by Institutional Resources for Supporting the Research Organization provided by the Czech Ministry of Health to Masaryk Memorial Cancer Institute.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Urology, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653, Brno, Czech Republic

    Michal Staník, Ivo Čapák, Daniel Macík, Martin Šustr, David Miklánek & Jan Doležel

  2. Department of Nuclear Medicine, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653, Brno, Czech Republic

    Jiří Vašina

  3. Department of Pathology, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653, Brno, Czech Republic

    Eva Lžičařová

  4. Institute of Biostatistics and Analyses, Masaryk University, Kamenice 3, 62500, Brno, Czech Republic

    Jiří Jarkovský

Authors
  1. Michal Staník
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ivo Čapák
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel Macík
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiří Vašina
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eva Lžičařová
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jiří Jarkovský
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Martin Šustr
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. David Miklánek
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jan Doležel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michal Staník.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Staník, M., Čapák, I., Macík, D. et al. Sentinel lymph node dissection combined with meticulous histology increases the detection rate of nodal metastases in prostate cancer. Int Urol Nephrol 46, 1543–1549 (2014). https://doi.org/10.1007/s11255-014-0704-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-014-0704-3

Keywords

Search

Navigation