title: Sentinel node approach in prostate cancer.
abstract: In general terms, one of the main objectives of sentinel lymph node (SLN) biopsy is to identify the 20-25% of patients with occult regional metastatic involvement. This technique reduces the associated morbidity from lymphadenectomy, as well as increasing the identification rate of occult lymphatic metastases by offering the pathologist those lymph nodes with the highest probability of containing metastatic cells. Pre-surgical lymphoscintigraphy is considered a "road map" to guide the surgeon towards the sentinel nodes and to ascertain unpredictable lymphatic drainages. In prostate cancer this aspect is essential due to the multidirectional character of the lymphatic drainage in the pelvis. In this context the inclusion of SPECT/CT should be mandatory in order to improve the SLN detection rate, to clarify the location when SLNs are difficult to interpret on planar images, to achieve a better definition of them in locations close to injection site, and to provide anatomical landmarks to be recognized during operation to locate SLNs. Conventional and laparoscopic hand-held gamma probes allow the SLN technique to be applied in any kind of surgery. The introduction and combination of new tracers and devices refines this technique, and the use of intraoperative images. These aspects become of vital importance due to the recent incorporation of robot-assisted procedures for SLN biopsy. In spite of these advances various aspects of SLN biopsy in prostate cancer patients still need to be discussed, and therefore their clinical application is not widely used.
authors.affiliation: Nuclear Medicine Department, Hospital Clínic Barcelona, Barcelona, Spain. Electronic address: svidal@clinic.ub.es.
authors.forename: S
authors.initials: S
authors.lastname: Vidal-Sicart
authors.affiliation: Interventional Molecular Imaging and Nuclear Medicine Section, Leiden University Medical Centre, Leiden, The Netherlands; Nuclear Medicine Department, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: Valdés Olmos
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000556:secondary*; D005544:Forecasting; D006801:Humans; D007267:Injections / Q000379:methods; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D061305:Lymphoscintigraphy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D060787:Neoplasm Grading; D009367:Neoplasm Staging / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology*; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012371:Robotics; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000295:instrumentation / Q000379:methods; D013668:Technetium Tc 99m Aggregated Albumin / Q000008:administration & dosage; D018084:Ultrasonography, Interventional
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid
keywords: Cáncer de próstata; Extended lymphadenectomy; Fluorescence; Fluorescencia; Imagen intraoperatoria; Intraoperative imaging; Intraoperative navigation; Linfadenectomía extendida; Navegación intraoperatoria; Prostate cancer; SPECT/TC