title: Detection rate and operating time required for gamma probe-guided sentinel lymph node resection after injection of technetium-99m nanocolloid into the prostate with and without preoperative imaging.
abstract: OBJECTIVE
  To investigate the usefulness of presurgical image fusion of three-dimensional single photon emission computed tomography (SPECT) with computed tomography/magnetic resonance imaging (CT/MRI) for detecting primary prostatic lymphatic landing sites (sentinel lymph nodes [SLNs]) using an intraoperative gamma probe in patients undergoing radical prostatectomy for organ-confined prostate cancer after intraprostatic (99m)Tc-nanocolloid injection.
  
  
  METHODS
  In 15 patients the surgeon was unaware of the preoperative SPECT/CT/MRI fusion imaging results. In 21 patients the surgeon was supported by the preoperative SPECT/CT/MRI images. Selective SLN resection was followed by an extended backup pelvic lymph node dissection (PLND) and radical prostatectomy.
  
  
  RESULTS
  In the group of 15 patients (gamma probe-guided SLN search only) presurgical SPECT/CT/MRI identified 137 SLNs (median of 10/patient; range: 2-19) and a total of 135 SLNs (median of 8/patient; range: 2-20) were detected intraoperatively (detection rate 98.5%). In the group of 21 patients with the surgeon knowing the preoperative SPECT/CT/MRI findings, 189 (median of 9/patient; range: 3-20) of the 190 imaged SLNs (median of 8/patient, range: 2-19) were found intraoperatively (detection rate 99.5%). Median operating time for sentinel lymphadenectomy using gamma probe only was 100 min (range: 40-130) versus 70 min (range: 20-140) for the SPECT/CT/MRI-supported resection (p=0.025). A median of 9 SLNs per patient (range: 2-19) was confirmed histologically.
  
  
  CONCLUSIONS
  Preoperative SPECT/CT/MRI is highly reliable to detect nonmetastatic sentinel nodes of the prostate. The operating time for SPECT/CT/MRI-supported SLN resection is significantly reduced compared to SLN resection guided by gamma probe alone. Both procedures take significantly longer than routine extended PLND.
authors.affiliation: Department of Urology, University Hospital of Bern, Bern, Switzerland.
authors.forename: Sebastian H
authors.initials: SH
authors.lastname: Warncke
authors.forename: Agostino
authors.initials: A
authors.lastname: Mattei
authors.forename: Frank G
authors.initials: FG
authors.lastname: Fuechsel
authors.forename: Sebastian
authors.initials: S
authors.lastname: Z'Brun
authors.forename: Thomas
authors.initials: T
authors.lastname: Krause
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010388:Pelvis; D011300:Preoperative Care / Q000379:methods; D011467:Prostate; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D015203:Reproducibility of Results; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013668:Technetium Tc 99m Aggregated Albumin / Q000008:administration & dosage; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid