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Lymph Node Fluorescence During Robot-Assisted Radical Prostatectomy With Indocyanine Green
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVE
To prospectively assess the ideal dosing and the value of fluorescent sentinel lymph node (LN) detection with indocyanine green (ICG) for the detection of LN metastases in intermediate- and high-risk patients undergoing robot-assisted prostatectomy and extended pelvic LN dissection (ePLND).
PATIENTS AND METHODS
Twenty patients received transperineal prostatic injections of ICG. Patients were cycled through 5 doses (1.25, 2.5, 3.75, 5, and 7.5 mg) so optimal ICG dosing could be discovered early.
RESULTS
ICG injection was able to identify fluorescent LN (FLN) packets in all 20 patients. Compared to the higher ICG doses, the 1.25 and 2.5 mg doses had fewer FLN packets and were abandoned after 1 dose each. The median number of FLN packets was 4.0, 6.0, and 4.5 for the respective doses of 3.75, 5.0, and 7.5 mg. The external iliac group was the most common site of fluorescence in 27.2% of patients, followed by the common iliac (21.3%), obturator (20.3%), internal iliac (18.5%), and node of Cloquet (7.7%). Seven (35%) of 20 patients had node-positive disease. Of the 5 patients that had fluorescent tissue outside of our ePLND template, 1 had a positive node present in the anterior bladder neck fat. Across all patients, ICG had 62% sensitivity, 50% specificity, 8% positive predictive value, and 95% negative predictive value in detecting LN metastases.
CONCLUSION
The low sensitivity of ICG for the detection of LN metastases highlights why FLN dissection with ICG does not represent an alternative to ePLND.
Additional Info
Disclosure statements are available on the authors' profiles:
Lymph Node Fluorescence During Robot-Assisted Radical Prostatectomy With Indocyanine Green: Prospective Dosing Analysis
Clin Genitourin Cancer 2017 Aug 01;15(4)e529-e534, A Chennamsetty, A Zhumkhawala, SB Tobis, N Ruel, CS Lau, J Yamzon, TG Wilson, BE YuhFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
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Among patients with intermediate- and high-risk prostate cancer, the choice of a pelvic lymph node dissection (PLND) template during prostatectomy is challenging. Although extended templates detect three times more lymph node (LN) metastases, limited PLNDs have a lower complication rate. In an effort to maximize benefit and minimize harm, targeted removal of LNs via sentinel dissection holds promise with near-infrared (NIR) fluorescent dye indocyanine green (ICG). However, prior studies evaluating ICG utility are difficult to compare due to varied dosage, injection location, and time interval. These studies1,2 address two variations—dosage and time interval. Whereas the first article confirms that ICG delivered during prostatectomy does not represent an alternative to extended PLND (no matter the dosage),1 the second article evaluates a second window technique (delivered 24 hours before the procedure).2 By reducing variables such as spillage and background signals, this proof-of-principle study identified all metastases (albeit with a false-positive rate). Future studies will need to confirm these findings in a larger sample before we can confidently abandon extended PLND for ICG-guided sentinel LN dissection.
References