title: Simplified intraoperative sentinel-node detection performed by the urologist accurately determines lymph-node stage in prostate cancer.
abstract: OBJECTIVE
  The reference standard for lymph-node staging in prostate cancer is currently an extended pelvic lymph-node dissection (ePLND), which detects most, but not all, regional lymph-node metastases. As an alternative to ePLND, sentinel-node dissection with preoperative isotope injection and imaging has been reported. The objective was to determine whether intraoperative sentinel-node detection with a simplified protocol can accurately determine lymph-node stage in prostate cancer patients.
  
  
  METHODS
  Patients with biopsy-verified high-risk prostate cancer with tumour stage T2-3 were included in the study. All patients underwent both ePLND and sentinel-node detection. (99m)Tc-marked nanocolloid was injected peritumourally by the operating urologist after induction of anaesthesia just before surgery. Sentinel nodes were detected both in vivo and ex vivo intraoperatively using a gamma probe. Sentinel nodes and metastases and their locations were recorded. Sensitivity and specificity were calculated.
  
  
  RESULTS
  At least one sentinel node was detected in 72 (87%) of the 83 patients. In 13 (18%) of these 72 patients sentinel nodes were detected outside the ePLND template. In six of these 13 patients, the Sentinel nodes from outside the template contained metastases, which proved to be the only metastases in two. For 12 patients the only metastatic deposit found was a micrometastasis (≤2 mm) in a sentinel node. In the 72 patients with detectable sentinel nodes, pathological analysis of the sentinel node correctly categorized 71 and ePLND 70 patients.
  
  
  CONCLUSIONS
  This protocol yielded results comparable to the commonly used technique of sentinel-node detection, but with more cases of non-detection.
authors.affiliation: Department of Surgery, Växjö Hospital, Lund University , Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Kjölhede
authors.forename: Ola
authors.initials: O
authors.lastname: Bratt
authors.forename: Sigurdur
authors.initials: S
authors.lastname: Gudjonsson
authors.forename: Pernilla
authors.initials: P
authors.lastname: Sundqvist
authors.forename: Fredrik
authors.initials: F
authors.lastname: Liedberg
mesh_terms: D000368:Aged; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D007267:Injections; D007432:Intraoperative Period; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012015:Reference Standards; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013667:Technetium / Q000008:administration & dosage
chemical_list: D013667:Technetium
keywords: Extended serial sectioning; immunohistochemistry; lymph-node staging; prostate cancer; sentinel lymph-node biopsy; sentinel node