title: Sentinel lymph node dissection combined with meticulous histology increases the detection rate of nodal metastases in prostate cancer.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Masaryk Memorial Cancer Institute, Žlutý Kopec 7, 65653, Brno, Czech Republic, stanik@mou.cz.
authors.forename: Michal
authors.initials: M
authors.lastname: Staník
authors.forename: Ivo
authors.initials: I
authors.lastname: Čapák
authors.forename: Daniel
authors.initials: D
authors.lastname: Macík
authors.forename: Jiří
authors.initials: J
authors.lastname: Vašina
authors.forename: Eva
authors.initials: E
authors.lastname: Lžičařová
authors.forename: Jiří
authors.initials: J
authors.lastname: Jarkovský
authors.forename: Martin
authors.initials: M
authors.lastname: Šustr
authors.forename: David
authors.initials: D
authors.lastname: Miklánek
authors.forename: Jan
authors.initials: J
authors.lastname: Doležel
mesh_terms: D000368:Aged; D001011:Aorta; D005188:False Negative Reactions; D006801:Humans; D007083:Iliac Artery; D007150:Immunohistochemistry; D007264:Inguinal Canal; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000737:chemistry / Q000473:pathology*; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D049451:Nomograms; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012007:Rectum; D012447:Sacrum; D021701:Sentinel Lymph Node Biopsy; D014057:Tomography, X-Ray Computed