Diagnostic Value, Oncological Outcomes And Safety Profile Of Image-Guided Surgery Technologies During Robot-Assisted Lymph Node Dissection with Sentinel Node Biopsy For Prostate Cancer.


Rationale: Despite good sensitivity and negative predictive value, the implementation of sentinel node biopsy (SNB) in robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (ePLND) for prostate cancer (PCa) is still controversial. Based on this premise, we aimed to define the added value of SNB (with different tracer modalities) to ePLND in the identification of nodal metastases. Complications rates and oncological outcomes were also assessed. Methods: From January 2006 to December 2019, prospectively collected data were retrospectively analyzed from a single institutional database regarding PCa patients all treated with RARP and ePLND with or without additional use of SNB, either with hybrid tracer indocyanine green (ICG)-99mTc-nanocolloid (ICG-99mTc-nanocolloid) or free ICG. Multivariable logistic and Cox regression models tested the impact of adding SNB (either with hybrid tracer or free-ICG) on lymph nodal invasion detection, complications and oncological outcomes. Results: Overall, 1680 patients were included in the final analysis. 1,168 (69.5%) were in the nonSNB-group, 161 (9.6%) in the ICGSNB-group and 351 (20.9%) patients in the HybridSNB-group. HybridSNB-group (OR 1.61, 95%CI 1.18-2.20, P = 0.002) was an independent predictor of nodal involvement, while ICGSNB-group did not reach the independent predictor status when compared to nonSNB group (OR 1.35, 95%CI 0.89-2.03, P = 0.1). SNB techniques were not associated with higher rates of complications. Lastly, use of HybridSNB was associated with lower rates of biochemical recurrence (0.79, 95%CI 0.63-0.98) and of clinical recurrence (HR 0.76, P = 0.035) compared to nonSNB group. Conclusion: The implementation of hybrid sentinel node biopsy technique with ICG-99mTc-nanocolloid in prostate cancer improves detection of positive nodes and potentially lowers recurrence rates with subsequent optimization of patient management, without harming patient safety.

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Journal of nuclear medicine : official publication, Society of Nuclear Medicine
  • Publication date 05-02-2021

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