COMMENTARY

Image-Guided Sentinel Node Localization in Prostate Cancer

Hossein Jadvar, MD, PhD, MPH, MBA

Disclosures

September 12, 2011

Intraoperative Imaging for Sentinel Node Identification in Prostate Carcinoma: Its Use in Combination With Other Techniques

Vermeeren L, Valdés Olmos RA, Meinhardt W, Horenblas S
J Nucl Med. 2011;52:741-744

Study Summary

The goal of this study was to evaluate the utility of a portable gamma camera for intraoperative identification and localization of sentinel nodes during laparoscopic sentinel lymphadenectomy in 55 men with prostate cancer. All men underwent preoperative planar lymphoscintigraphy and SPECT/CT following transrectal ultrasound-guided Tc-99m nanocolloid injection at 4 locations (total dose of 225 MBq with each deposit of 0.1 mL followed by a 0.7 mL saline flush) into the prostate gland. A total of 178 nodes were seen on SPECT/CT (142 on planar images), and 16% of these nodes could not be detected with the portable gamma camera. The corresponding portable camera miss rate for planar images was 6%. The use of a radioactive source (I-125 seed) as a pointer also enabled efficient localization of nodes.

Viewpoint

Sentinel lymph node lymphoscintigraphy and intraoperative gamma probe are commonly employed in breast cancer staging. Similar techniques have recently been explored in prostate cancer.[1,2] This interesting study from The Netherlands showed the value of image-guided sentinel node localization in prostate cancer, a technique that will hopefully allow more accurate staging and guided treatment that may lead to improved overall clinical outcomes. The surgeon can position the detector over the surgical field to find the sentinel node corresponding to the preoperative SPECT/CT image.

Overall, this technique resulted in excision of more sentinel nodes. It was also determined that intraoperative imaging cannot replace preoperative images. Among the factors found to be significantly associated with intraoperative sentinel node visualization were number of sentinel nodes on preoperative planar or SPECT/CT images and Gleason sum score. The gamma probe also allowed interrogation of the surgical field for adequacy of radioactive node excision.

Abstract

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