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Title: Mapping of pelvic lymph node metastases in prostate cancer
Authors: Van den Bergh, Luc ×
Joniau, Steven
Budiharto, Tom
Lerut, Evelyne
Deroose, Christophe
Oyen, Raymond
Ameye, F
Haustermans, Karin
Van Poppel, Hendrik #
Issue Date: Mar-2011
Publisher: Elsevier Science
Host Document: European Urology Supplements vol:10 issue:2 pages:187-187
Conference: Annual Congress of the European Association of Urology edition:26 location:Vienna, Austria date:18-22 March 2011
Article number: 568
Abstract: Introduction & Objectives: Series of extended lymph node dissection (eLND) have shown that the actual rate of lymph node (LN) metastases is higher than observed with obturator LND (oLND). The objective of this study is to present a precise map of the affected LN regions assessing the potential benefit of a superextended LND (seLND) completed with a sentinel node (SN) procedure in patients
at high risk for LN involvement.
Materials & Methods: Patients with a risk ≥10% but <35% of LN metastases (Partin tables) and who were N0 at contrast-enhanced CT, were prospectively enrolled. All patients underwent a SN procedure and seLND (internal, external and
common iliac, obturator fossa and presacral), followed by radical prostatectomy.
All LN were serially sectioned (each 300μ) and completely histopathologically examined.
Results: So far, 60 patients are available for analysis. Of all resected SN (n=244), 97% (n=236) were located within the seLND template, while 3% (n=8) were located in the pararectal, paraaortic and paravesical regions. 28 patients (47%) had a pN1 stage and in total, 67/1208 LN were positive. The anatomical map of affected LN is shown in Fig 1. In 5 (18%), 3 (11%), 5 (18%) and 1 (4%) patients, the affected nodes were exclusively located at the obturator fossa, external iliac, internal iliac and paraaortic regions respectively. Importantly, oLND only would have correctly staged 11/28 (39%) patients as N+ and would only have adequately removed all affected nodes in 5/28 (18%). A standard eLND (external iliac, obturator and internal iliac) would have correctly staged 26/28 patients (93%) as N+, but would only have adequately removed all affected nodes in 22/28 (79%).
Conclusions: In this group of patients at high risk of LN metastases, a standard eLND would have correctly staged the vast majority (93%) of patients. However, 21% of affected nodes would have been left behind, potentially leading to higher rates of biochemical recurrence in the follow-up period. Adding the presacral LN seems to be of particular interest in overcoming this problem, while resection of the
common iliac LN and the use of a SN procedure contributes in a smaller amount of patients.
ISSN: 1569-9056
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Laboratory of Experimental Radiotherapy
Urology Section (-)
Translational Cell & Tissue Research
Nuclear Medicine & Molecular Imaging
Radiology
Clerkships Office, Faculty of Medicine - miscellaneous
× corresponding author
# (joint) last author

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