RESUMEN
OBJECTIVES: The lymph node metastasis is an important prognostic factor in prostatic cancer. The aim of this prospective study was to evaluate the relevance of the sentinel lymph node biopsy by laparoscopy in staging locoregional patients with clinically localized PC. PATIENTS AND METHODS: A transrectal ultrasound-guided injection by 0.3 mL/100 MBq (99m)Tc-sulfur rhenium colloid in each prostatic lobe was performed the day before surgery. The detection was realized intraoperatively with a laparoscopic probe (Clerad(®) Gamma Sup) followed by extensive dissection. Counts of SLN were performed in vivo and confirmed ex vivo. The histological analysis was performed by hematoxyline-phloxine-safran staining and followed by immunochemistry if SLN is free. RESULTS: Seventy patients with carcinoma of the prostate at intermediate or high risk of lymph node metastases were included. The intraoperative detection rate was 68/70 (97%). Fourteen patients had lymph node metastases, six only in SLN. The false negative rate was 2/14 (14%). The internal iliac region was the first metastatic site (40.9%). A metastatic sentinel node in common iliac region beyond the ureteral junction was present in 18.2%. A non-negligible sentinel metastatic region was the common iliac area (18.2%). Limited or standard lymph node dissection would have ignored respectively 72.7% and 59% of lymph node metastases. CONCLUSION: The laparoscopy is adapted to a broad identification of SLN and targeted dissection of these lymph nodes significantly limited the risk of surgical extended dissection while maintaining the accuracy of the information.
Asunto(s)
Laparoscopía , Escisión del Ganglio Linfático/métodos , Metástasis Linfática/diagnóstico , Neoplasias de la Próstata/patología , Biopsia del Ganglio Linfático Centinela , Anciano , Carcinoma/patología , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Cintigrafía , Radiofármacos , Azufre Coloidal Tecnecio Tc 99m , Ultrasonografía IntervencionalRESUMEN
INTRODUCTION: Lung cancer, a major application of FDG/PET-CT, has recently been introduced in daily practice in France. The authors retrospectively studied its impact on the management of this disease. METHODS: The results of PET-CT and conventional assessment (brain imaging, chest and abdominal CT and possibly bone scintigraphy) were compared in 94 patients, referred for the staging of non-small cell lung cancer, or the assessment of a solitary lung lesion. The impact of thoracic lymph node involvement on the operability of patients was studied in 44 patients. RESULTS: PET-CT revealed metastases in 20% of the patients without metastases found by conventional imaging and modified the stage of the disease in 28% of the cases. It changed the indication of surgical treatment in 19% of the cases and led to induction chemotherapy in two patients. In addition, two synchronous cancers were discovered. Regarding lymph node involvement, PET-CT remains of diagnostic value regardless of the scanner results. CONCLUSION: The impact of PET-CT in assessing non-small cell lung cancer was confirmed in the authors' practice. Its interest and the consequences in some patients misclassified with conventional assessment have been demonstrated.