title: [Utility of SPECT/CT scan for anatomical localization of pararectal and presacral sentinel nodes in prostate cancer].
abstract: OBJECTIVE
  This study has aimed to evaluate the added value of SPECT-CT scan in the preoperative assessment of sentinel nodes of the presacral and pararectal regions localized outside the standard area of extended pelvic lymphadenectomy for the staging of the pelvis in prostate cancer. SPECT-CT scan can serve as a guide for the excision of these nodes by lymphadenectomy by open surgery or laparoscopy.
  
  
  METHODS
  We evaluated 4 patients with prostate cancer presenting sentinel nodes in the pararectal and presacral regions on SPECT-CT scan performed in addition to lymphoscintigraphy. These patients underwent lymphadenectomy with robot-assisted laparoscopy together with prostatectomy. All of the excised lymph nodes were sent for histopathology study.
  
  
  RESULTS
  An average of 6 sentinel nodes per patient were found on SPECT-CT scan with a mean of 2 sentinel nodes in presacral/pararectal región. Lymphadenectomy including these areas was performed. Pararectal/presacral sentinel nodes of all patients depicted by SPECT-CT scan were tumor free on histopathology study. Sentinel nodes (no pararectal/presacral) were positive for malignancy in only one patient.
  
  
  CONCLUSIONS
  Preoperative SPECT-CT scan is a useful tool to localize the sentinel nodes in pararectal/presacral regions. It can be an anatomic guide for new modalities of laparoscopic surgery such as robot-assisted procedures that can access the pelvic areas visualized with SPECT-CT scan, making excision of these nodes possible.
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Madrid, España; Department of Nuclear Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Holanda. Electronic address: jreichicharo10@gmail.com.
authors.forename: J R
authors.initials: JR
authors.lastname: Chícharo de Freitas
authors.affiliation: Department of Nuclear Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Holanda; Department of Radiology, Leiden University Medical Center, Leiden, Holanda.
authors.forename: G H
authors.initials: GH
authors.lastname: KleinJan
authors.affiliation: Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Holanda.
authors.forename: H G
authors.initials: HG
authors.lastname: van der Poel
authors.affiliation: Department of Nuclear Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Holanda; Department of Radiology, Leiden University Medical Center, Leiden, Holanda.
authors.forename: N S
authors.initials: NS
authors.lastname: van den Berg
authors.affiliation: Department of Nuclear Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Holanda.
authors.forename: E
authors.initials: E
authors.lastname: Vegt
authors.affiliation: Department of Nuclear Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Holanda.
authors.forename: M P
authors.initials: MP
authors.lastname: Stokkel
authors.affiliation: Department of Nuclear Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Holanda; Department of Radiology, Leiden University Medical Center, Leiden, Holanda.
authors.forename: R A
authors.initials: RA
authors.lastname: Valdés Olmos
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D061305:Lymphoscintigraphy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology*; D012007:Rectum; D012371:Robotics; D012445:Sacrococcygeal Region; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Cáncer de próstata; Ganglio centinela; Prostate cancer; SPECT-CT scan; SPECT-TC; Sentinel node