title: Lymphatic drainage in prostate carcinoma assessed by lymphoscintigraphy and SPECT/CT: its importance for the sentinel node procedure.
abstract: OBJECTIVE
  The goal was to evaluate the sentinel node procedure in relation to different pathways of lymphatic drainage and the areas of pelvic lymphadenectomy in patients with prostate cancer assessed by lymphoscintigraphy and SPECT/CT study.
  
  
  METHODS
  Eighteen patients with prostate cancer of intermediate prognosis were injected with 240 MBq of (99m)Tc-nanocolloid in the peripheral zone of each quadrant of the prostate, guided by transrectal ultrasonography. Tracer administration was also controlled with a portable gamma camera to assure that there was no diffusion outside the prostate. The injection was followed by planar imaging at 15 min. and 2 h, performing a SPECT/CT study at 2 h. with 2 mm slices. On the same day, a laparoscopic sentinel node lymphadenectomy assisted by a gamma probe and a portable gamma camera was performed.
  
  
  RESULTS
  A total of 55 sentinel lymph nodes (SLNs) were visualized. In 17/18 of patients (94%) SLNs were observed outside the obturator region. Twenty SLNs (36%) were observed along the external iliac artery, 14 in the obturator fossa (25.4%), 6 in internal iliac area (11%) and 4 in common iliac region (7.2%). Three SLNs were visualized in presacral (5.4%), paraaortic (5.4%), and pararectal areas (5.4%) and two in paravesical region (3.6%). SLN metastases were found in 6 patients (33%), and in one of them, a SLN located along the common iliac artery, was the only one with metastases.
  
  
  CONCLUSIONS
  Lymphatic drainage from the prostate has high individual variability, and direct drainage outside the pelvic area is observed frequently. With the SLN procedure, SLNs outside the routine area of lymphadenectomy can also be sampled to stage the patient more accurately.
authors: Department of Nuclear Medicine, University Hospital Virgen Macarena, Sevilla, Spain. abonilladamia@gmail.com
authors: A
authors: A
authors: de Bonilla-Damiá
authors: O
authors: O
authors: Roberto Brouwer
authors: W
authors: W
authors: Meinhardt
authors: R A
authors: RA
authors: Valdés-Olmos
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D000368:Aged; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008208:Lymphatic System / Q000473:pathology; D061305:Lymphoscintigraphy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D010388:Pelvis; D049268:Positron-Emission Tomography; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid