title: Indocyanine Green Guided Pelvic Lymph Node Dissection: An Efficient Technique to Classify the Lymph Node Status of Patients with Prostate Cancer Who Underwent Radical Prostatectomy.
abstract: We evaluated the effectiveness of indocyanine green guided pelvic lymph node dissection for the optimal staging of prostate cancer and analyzed whether the technique could replace extended pelvic lymph node dissection.
  
  
  
  A solution of 25 mg indocyanine green in 5 ml sterile water was transperineally injected. Pelvic lymph node dissection was started with the indocyanine green stained nodes followed by extended pelvic lymph node dissection. Primary outcome measures were sensitivity, specificity, predictive value and likelihood ratio of a negative test of indocyanine green guided pelvic lymph node dissection.
  
  
  
  A total of 84 patients with a median age of 63.55 years and a median prostate specific antigen of 8.48 ng/ml were included in the study. Of these patients 60.7% had intermediate risk disease and 25% had high or very high risk disease. A median of 7 indocyanine green stained nodes per patient was detected (range 2 to 18) with a median of 22 nodes excised during extended pelvic lymph node dissection. Lymph node metastasis was identified in 25 patients, 23 of whom had disease properly classified by indocyanine green guided pelvic lymph node dissection. The most frequent location of indocyanine green stained nodes was the proximal internal iliac artery followed by the fossa of Marcille. The negative predictive value was 96.7% and the likelihood ratio of a negative test was 8%. Overall 1,856 nodes were removed and 603 were stained indocyanine green. Pathological examination revealed 82 metastatic nodes, of which 60% were indocyanine green stained. The negative predictive value was 97.4% but the likelihood ratio of a negative test was 58.5%.
  
  
  
  Indocyanine green guided pelvic lymph node dissection correctly staged 97% of cases. However, according to our data it cannot replace extended pelvic lymph node dissection. Nevertheless, its high negative predictive value could allow us to avoid extended pelvic lymph node dissection if we had an accurate intraoperative lymph fluorescent analysis.
authors.affiliation: Department of Urology, Valencian Oncology Institute, FIVO, Almeria, Andalusia, Spain. Electronic address: ramirezbackhaus@yahoo.es.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ramírez-Backhaus
authors.affiliation: Department of Urology, Valencian Oncology Institute, FIVO, Almeria, Andalusia, Spain.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Mira Moreno
authors.affiliation: Department of Urology, Valencian Oncology Institute, FIVO, Almeria, Andalusia, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Gómez Ferrer
authors.affiliation: Pathology Department FIVO, Almeria, Andalusia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Calatrava Fons
authors.affiliation: Department of Urology, Valencian Oncology Institute, FIVO, Almeria, Andalusia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Casanova
authors.affiliation: Department of Urology, Valencian Oncology Institute, FIVO, Almeria, Andalusia, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Solsona Narbón
authors.affiliation: Mathematics Department, University of Almería, Almeria, Andalusia, Spain.
authors.forename: Isabel María
authors.initials: IM
authors.lastname: Ortiz Rodríguez
authors.affiliation: Department of Urology, Valencian Oncology Institute, FIVO, Almeria, Andalusia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Rubio Briones
mesh_terms: D000368:Aged; D004396:Coloring Agents; D006801:Humans; D007208:Indocyanine Green; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D025321:Surgery, Computer-Assisted
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: prostatectomy; prostatic neoplasms; sentinel lymph node biopsy