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Engels S, Michalik B, Dirks L, van Oosterom MN, Wawroschek F, Winter A. A Fluorescent and Magnetic Hybrid Tracer for Improved Sentinel Lymphadenectomy in Prostate Cancer Patients. Biomedicines 2023; 11:2779. [PMID: 37893150 PMCID: PMC10604386 DOI: 10.3390/biomedicines11102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
In prostate cancer, sentinel lymph node dissection (sLND) offers a personalized procedure with staging ability which is at least equivalent to extended LND while inducing lower morbidity. A bimodal fluorescent-radioactive approach was introduced to improve sentinel LN (SLN) detection. We present the first in-human case series on exploring the use of a fluorescent-magnetic hybrid tracer in a radiation-free sLND procedure. Superparamagnetic iron oxide nanoparticles and indocyanine green were administered simultaneously in five prostate cancer patients scheduled for extended LND, sLND and radical prostatectomy. In situ and ex vivo fluorescence and magnetic signals were documented for each LN sample detected via a laparoscopic fluorescence imaging and magnetometer system. Fluorescence and magnetic activity could be detected in all patients. Overall, 19 lymph node spots could be detected in situ, 14 of which were fluorescently active and 18 of which were magnetically active. In two patients, no fluorescent LNs could be detected in situ. The separation of the LN samples resulted in a total number of 30 SLNs resected. Ex vivo measurements confirmed fluorescence in all but two magnetically active SLNs. One LN detected in situ with both modalities was subsequently shown to contain a metastasis. This study provides the first promising results of a bimodal, radiation-free sLND, combining the advantages of both the magnetic and fluorescence approaches.
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Affiliation(s)
- Svenja Engels
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (S.E.); (B.M.); (L.D.); (F.W.)
| | - Bianca Michalik
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (S.E.); (B.M.); (L.D.); (F.W.)
| | - Lena Dirks
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (S.E.); (B.M.); (L.D.); (F.W.)
| | - Matthias N. van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Friedhelm Wawroschek
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (S.E.); (B.M.); (L.D.); (F.W.)
| | - Alexander Winter
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (S.E.); (B.M.); (L.D.); (F.W.)
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Rossin G, Zorzi F, De Pablos-Rodríguez P, Biasatti A, Marenco J, Ongaro L, Perotti A, Tulone G, Traunero F, Piasentin A, Gomez-Ferrer A, Zucchi A, Trombetta C, Simonato A, Rubio-Briones J, Bartoletti R, Ramírez-Backhaus M, Claps F. Sentinel Lymph Node Biopsy in Prostate Cancer: An Overview of Diagnostic Performance, Oncological Outcomes, Safety, and Feasibility. Diagnostics (Basel) 2023; 13:2543. [PMID: 37568905 PMCID: PMC10416990 DOI: 10.3390/diagnostics13152543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Sentinel node biopsy (SNB) for prostate cancer (PCa) represents an innovative technique aimed at improving nodal staging accuracy. The routinary adoption of this procedure in patients undergoing radical prostatectomy (RP) might be crucial to identify candidates who could effectively benefit from extensive pelvic lymph nodal dissection (ePLND). Despite some promising results, SNB for PCa is still considered experimental due to the lack of solid evidence and procedural standardization. In this regard, our narrative review aimed to analyze the most recent literature in this field, providing an overview of both the diagnostic accuracy measures and the oncological outcomes of SNB.
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Affiliation(s)
- Giulio Rossin
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Federico Zorzi
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Pedro De Pablos-Rodríguez
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain; (P.D.P.-R.); (J.M.); (A.G.-F.); (M.R.-B.)
| | - Arianna Biasatti
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Josè Marenco
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain; (P.D.P.-R.); (J.M.); (A.G.-F.); (M.R.-B.)
| | - Luca Ongaro
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Alessandro Perotti
- Department of Translational Research and New Technologies, University of Pisa, 56126 Pisa, Italy; (A.P.); (A.Z.); (R.B.)
| | - Gabriele Tulone
- Urology Clinic, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90133 Palermo, Italy; (G.T.); (A.S.)
| | - Fabio Traunero
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Andrea Piasentin
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Alvaro Gomez-Ferrer
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain; (P.D.P.-R.); (J.M.); (A.G.-F.); (M.R.-B.)
| | - Alessandro Zucchi
- Department of Translational Research and New Technologies, University of Pisa, 56126 Pisa, Italy; (A.P.); (A.Z.); (R.B.)
| | - Carlo Trombetta
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Alchiede Simonato
- Urology Clinic, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90133 Palermo, Italy; (G.T.); (A.S.)
| | - José Rubio-Briones
- Clínica de Urología, Hospital VITHAS 9 de Octubre, 46015 Valencia, Spain;
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, 56126 Pisa, Italy; (A.P.); (A.Z.); (R.B.)
| | - Miguel Ramírez-Backhaus
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain; (P.D.P.-R.); (J.M.); (A.G.-F.); (M.R.-B.)
| | - Francesco Claps
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain; (P.D.P.-R.); (J.M.); (A.G.-F.); (M.R.-B.)
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Wit EMK, KleinJan GH, Berrens AC, van Vliet R, van Leeuwen PJ, Buckle T, Donswijk ML, Bekers EM, van Leeuwen FWB, van der Poel HG. A hybrid radioactive and fluorescence approach is more than the sum of its parts; outcome of a phase II randomized sentinel node trial in prostate cancer patients. Eur J Nucl Med Mol Imaging 2023; 50:2861-2871. [PMID: 37036490 DOI: 10.1007/s00259-023-06191-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/05/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE To determine the diagnostic accuracy of the hybrid tracer indocyanine green (ICG)-Technetium-99 m(99mTc)-nanocolloid compared to sequential tracers of 99mTc-nanocolloid and free-ICG in detecting tumor-positive lymph nodes (LN) during primary surgery in prostate cancer (PCa) patients. INTRODUCTION Image-guided surgery strategies can help visualize individual lymphatic drainage patterns and sentinel lymph nodes (SLNs) in PCa patients. For lymphatic mapping radioactive, fluorescent and hybrid tracers are being clinically exploited. In this prospective randomized phase II trial, we made a head-to-head comparison between ICG-99mTc-nanocolloid (hybrid group) and 99mTc-nanocolloid and subsequent free-ICG injection (sequential group). METHODS PCa patients with a >5% risk of lymphatic involvement according to the 2012 Briganti nomogram and planned for prostatectomy were included and randomized (1:1) between ultrasound-guided intraprostatic tracer administration of ICG-99mTc-nanocolloid (n = 69) or 99mTc-nanocolloid (n = 69) 5 h before surgery. Preoperative lymphoscintigraphy and SPECT/CT were performed to define the locations of the SLNs. Additionally, all participants in the sequential group received an injection of free-ICG at time of surgery. Subsequently, all (S)LNs were dissected using fluorescence guidance followed by an extended pelvic lymph node dissection (ePLND). The primary outcome was the total number of surgically removed (S)LNs and tumor-positive (S)LNs. RESULTS The total number of surgically removed (S)LN packages was 701 and 733 in the hybrid and sequential groups, respectively (p = 0.727). The total number of fluorescent LNs retrieved was 310 and 665 nodes in the hybrid and sequential groups, respectively (p < 0.001). However, no statistically significant difference was observed in the corresponding number of tumor-positive nodes among the groups (44 vs. 33; p = 0.470). Consequently, the rate of tumor-positive fluorescent LNs was higher in the hybrid group (7.4%) compared to the sequential group (2.6%; p = 0.002), indicating an enhanced positive predictive value for the hybrid approach. There was no difference in complications within 90 days after surgery (p = 0.78). CONCLUSIONS The hybrid tracer ICG-99mTc-nanocolloid improved the positive predictive value for tumor-bearing LNs while minimizing the number of fluorescent nodes compared to the sequential tracer approach. Consequently, the hybrid tracer ICG-99mTc-nanocolloid enables the most reliable and minimal invasive method for LN staging in PCa patients.
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Affiliation(s)
- Esther M K Wit
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Gijs H KleinJan
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne-Claire Berrens
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Roos van Vliet
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Tessa Buckle
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Elise M Bekers
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Fijs W B van Leeuwen
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Xie D, Gu D, Lei M, Cai C, Zhong W, Qi D, Wu W, Zeng G, Liu Y. The application of indocyanine green in guiding prostate cancer treatment. Asian J Urol 2023; 10:1-8. [PMID: 36721695 PMCID: PMC9875158 DOI: 10.1016/j.ajur.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 05/31/2021] [Accepted: 07/13/2021] [Indexed: 02/03/2023] Open
Abstract
Objective Indocyanine green (ICG) with near-infrared fluorescence absorption is approved by the United States Food and Drug Administration for clinical applications in angiography, blood flow evaluation, and liver function assessment. It has strong optical absorption in the near-infrared region, where light can penetrate deepest into biological tissue. We sought to review its value in guiding prostate cancer treatment. Methods All related literature at PubMed from January 2000 to December 2020 were reviewed. Results Multiple preclinical studies have demonstrated the usefulness of ICG in identifying prostate cancer by using different engineering techniques. Clinical studies have demonstrated the usefulness of ICG in guiding sentinel node dissection during radical prostatectomy, and possible better preservation of neurovascular bundle by identifying landmark prostatic arteries. New techniques such as adding fluorescein in additional to ICG were tested in a limited number of patients with encouraging result. In addition, the use of the ICG was shown to be safe. Even though there are encouraging results, it does not carry sufficient sensitivity and specificity in replacing extended pelvic lymph node dissection during radical prostatectomy. Conclusion Multiple preclinical and clinical studies have shown the usefulness of ICG in identifying and guiding treatment for prostate cancer. Larger randomized prospective studies are warranted to further test its usefulness and find new modified approaches.
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Fluorescence-guided extended pelvic lymphadenectomy during robotic radical prostatectomy. J Robot Surg 2022; 17:885-890. [DOI: 10.1007/s11701-022-01480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
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Fumadó L, Abascal JM, Mestre-Fusco A, Vidal-Sicart S, Aguilar G, Juanpere N, Cecchini L. Sentinel Lymph Node Biopsy in Prostate Cancer Patients: Results From an Injection Technique Targeting the Index Lesion in the Prostate Gland. Front Med (Lausanne) 2022; 9:931867. [PMID: 36117970 PMCID: PMC9478858 DOI: 10.3389/fmed.2022.931867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives To determine the accuracy of nodal staging in patients with prostate cancer (PCa) when 99mTc-nanocolloid radiotracer is injected into an index lesion (IL). Methods This prospective study was conducted at our institution between June 2016 and October 2020. It included 64 patients with localized PCa with at least a 5% possibility for lymph node involvement in the Memorial Sloan Kettering Cancer Center nomogram, suitable for surgical treatment. All patients underwent magnetic resonance imaging (MRI) with IL and were pathologically confirmed. The day before surgery, transrectal ultrasound-guided injection (TRUS) of 99mTc-nanocolloid into the IL was performed. Surgical procedures included radical prostatectomy (RP), sentinel lymph node biopsy (SLNB), and extended pelvic lymphadenectomy (ePLND). Analysis was performed, including histopathological findings of RP, ePLND, and SLNB. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative (FN), false positive (FP), diagnostic yield, and non-diagnostic rate were calculated. Results A total of 1,316 lymph nodes were excised, including 1,102 from the ePLND (83.7%) and 214 (16.3%) sentinel lymph nodes (SLN). 26 SLN were dissected outside the ePLND template. The final pathology demonstrated 46 (3.5%) lymph node metastasis, 31 (67.4%) in the SLNB and 15 (32.6%) in the non-SLN ePLND. At the patient level, 18 (28.1%) patients had pN1. With a mean follow-up of 33.1 months, 4/19 (21.1%) pN1 patients had undetectable PSA, and 3/19 (15.8%) had a PSA < 0.1 ng/mL. Lymph node dissection included 20.6 lymph nodes per patient (IQR 15–24.2), with 3.3 SLNB nodes per patient (IQR 2–4.2). PPV and NPV were 100 and 97.8%, respectively. Sensitivity and specificity were 94.4 and 100%, respectively. FN was 5.5% and FP was 4.3%. Diagnostic yields were 95.3% and the non-diagnostic rate was 4.7%. Conclusion Radiotracer injection into the prostate IL offers promising results for staging purposes in cases in which ePLND is considered. Negative SLNB is a predictor of negative ePLND. Patients with a limited burden of nodal metastasis have a significant chance of remaining free of biochemical recurrence at mid-term follow-up.
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Affiliation(s)
- Lluís Fumadó
- Department of Urology, Hospital del Mar, Barcelona, Spain
- *Correspondence: Lluís Fumadó,
| | | | - Antoni Mestre-Fusco
- Department of Nuclear Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clínic i Provincial, Barcelona, Spain
| | | | - Nuria Juanpere
- Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - Lluís Cecchini
- Department of Urology, Hospital del Mar, Barcelona, Spain
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Free-indocyanine green-guided pelvic lymph node dissection during radical prostatectomy. Urol Oncol 2022; 40:489.e19-489.e26. [DOI: 10.1016/j.urolonc.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/08/2022] [Accepted: 08/07/2022] [Indexed: 11/24/2022]
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Urabe F, Kimura S, Yasue K, Yanagisawa T, Tsuzuki S, Kimura T, Miki J, Egawa S. Performance of Indocyanine Green Fluorescence for Detecting Lymph Node Metastasis in Prostate Cancer: A Systematic Review and Meta-analysis. Clin Genitourin Cancer 2021; 19:466.e1-466.e9. [PMID: 34130916 DOI: 10.1016/j.clgc.2021.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/07/2021] [Accepted: 03/13/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The use of sentinel lymph node dissection in several cancers has been gaining attention with the emergence of indocyanine green fluorescence. We performed a meta-analysis to assess the diagnostic performance of indocyanine green fluorescence in detecting lymph node metastasis in prostate cancer patients. METHODS A literature search was conducted using PubMed, Cochrane Library, and SCOPUS on November 30, 2020, to identify eligible studies. Studies were eligible if they investigated the diagnostic performance of indocyanine green fluorescence before pelvic lymph node dissection in prostate cancer patients and reported the number of true positives, false positives, false negatives, and true negatives on lymph node-based analysis in comparison to histopathologic findings in the dissected specimen. RESULTS Our systematic review covered 11 studies published between 2011 and 2020, with 519 patients, and our meta-analysis included 9 studies with 479 patients. Based on lymph node analysis of indocyanine green fluorescence, the results showed pooled sensitivity and specificity at 0.75 (95% confidence interval [CI] 0.49 to 0.90) and 0.66 (95% CI 0.61 to 0.70), respectively. The diagnostic odds ratio was 6.0 (95%CI 2 to 21). Several lymphatic drainage routes also showed sentinel lymph nodes localized outside the ordinal pelvic lymph node template. CONCLUSIONS We noted relatively low diagnostic performance for lymph node metastasis, suggesting that indocyanine fluorescence may not currently be a viable alternative to pelvic lymph node dissection in prostate cancer patients. However, this technique shows novel lymphatic drainage routes and underscores the importance of lymph nodes not removed in ordinary dissection.
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Affiliation(s)
- Fumihiko Urabe
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
| | - Shoji Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Keiji Yasue
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
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Salvage Pelvic Lymph Node Dissection and Current State of Imaging for Recurrent Prostate Cancer: Does a Standard Exist? Curr Urol Rep 2020; 21:62. [PMID: 33159608 DOI: 10.1007/s11934-020-01011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW We aim to evaluate the efficacy of salvage lymph node dissection (SLND) for nodal recurrent prostate cancer after primary treatment. We also provide a review of the diagnostic performance of next-generation sequencing (next-generation imaging (NGI)) radiotracers in the salvage setting. RECENT FINDINGS Most studies evaluating SLND include a heterogeneous population with a small sample size and are retrospective in design. The 5-year clinical recurrence-free and cancer-specific survival following SLND are 26-52% and 57-89%, respectively, among prospective studies. NGI improves accuracy in detecting nodal recurrence compared to conventional CT, with PMSA PET-CT showing the most promise. However, limited studies exist comparing imaging modalities and performance is variable at low PSA values. SLND is a promising treatment option, but more prospective data are needed to determine the ideal surgical candidate and long-term oncologic outcomes. More studies comparing different NGI are needed to determine the best imaging modality in patients who may be candidates for salvage treatment.
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Shimbo M, Endo F, Matsushita K, Hattori K. Impact of indocyanine green‐guided extended pelvic lymph node dissection during robot‐assisted radical prostatectomy. Int J Urol 2020; 27:845-850. [DOI: 10.1111/iju.14306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/04/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Masaki Shimbo
- Department of Urology St. Luke’s International Hospital Tokyo Japan
| | - Fumiyasu Endo
- Department of Urology St. Luke’s International Hospital Tokyo Japan
| | | | - Kazunori Hattori
- Department of Urology St. Luke’s International Hospital Tokyo Japan
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Grivas N, van den Bergh RCN, Brouwer OR, KleinJan GH, Ramirez-Backhaus M, Wilthagen EA, van der Poel HG. Pelvic lymph node distribution and metastases of prostate and bladder cancer: a systematic literature review and template proposal. World J Urol 2020; 39:751-759. [PMID: 32495153 DOI: 10.1007/s00345-020-03281-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To systematically review the relevant literature that evaluates the LN topographical distribution and propose a uniform template. METHODS A bibliographic search of PubMed/Medline, Embase and SCOPUS was performed for studies reporting data of LN imaging and/or nodal resection. RESULTS 101 and 26 articles met the inclusion criteria for PCa and BCa, respectively. In PCa, the most common locations of positive LNs for surgical and imaging studies were external iliac (both 38 studies), followed by obturator (38 and 37, respectively). Similarly, in BCa, the most common location of positive nodes for surgical and imaging studies were external iliac (19 and 4, respectively), followed by obturator (15 and 3 studies, respectively). In PCa, median percentages of positive external iliac nodes/patient were 12.2% and 11.6% for surgical and imaging studies, respectively while corresponding rates for BCa were 3.9% and 17.6%. There were high risks of bias across studies as well as high heterogeneity in the definition of the anatomic boundaries of lymphadenectomy templates. CONCLUSIONS This review highlights the lack of detailed information on exact LN templates and metastases location, which in turn hinders generation of high-quality evidence on optimal lymphadenectomy templates. Our proposed template is applicable for both imaging and surgical description and could facilitate the translation of anatomical location from imaging to surgical resection.
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Affiliation(s)
- Nikolaos Grivas
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands.
| | | | - Oscar R Brouwer
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
| | - Gijs H KleinJan
- Department of Urology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Erica A Wilthagen
- Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
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Furubayashi N, Negishi T, Uozumi T, Shiraishi K, Taguchi K, Shimokawa M, Nakamura M. Eliminating microscopic lymph node metastasis by performing pelvic lymph node dissection during radical prostatectomy for prostate cancer. Mol Clin Oncol 2019; 12:104-110. [PMID: 31929879 PMCID: PMC6951226 DOI: 10.3892/mco.2019.1965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/25/2019] [Indexed: 11/27/2022] Open
Abstract
The oncological benefit of pelvic lymph node dissection (PLND) for prostate cancer (PCa) remains unclear. The therapeutic effect of PLND on the elimination of microscopic metastases during radical prostatectomy (RP) for PCa was examined in the current study. A total of 348 Japanese patients with high- or intermediate-risk PCa without lymph node metastasis, who underwent antegrade RP at the Kyushu Cancer Center (Fukuoka, Japan) between August 1998 and May 2013 were retrospectively analyzed. The patients were divided into the standard (obturator + internal iliac nodes) group and the expanded (standard + additional nodes) group according to the extent of PLND. Preoperative and postoperative characteristics were also analyzed to determine the factors associated with prostate-specific antigen (PSA) failure. Standard and expanded PLND were performed in 70.9% (247/348) and 29.1% (101/348) of cases, respectively. The results revealed that preoperative PSA levels were the only marked difference between the two groups. No differences were observed in the other preoperative and postoperative characteristics. Furthermore, the rate of PSA recurrence in each group did not differ to a statistically significant extent (P=0.3622). Reducing the area of dissection from expanded PLND to standard PLND significantly reduced the number of dissected lymph nodes (P<0.0001). Additionally, the PSA level, clinical tumor stage, Gleason score of the biopsy specimen, pathological tumor stage and extent of PLND were all associated with PSA recurrence, as determined via multivariate Cox hazards regression analysis (P=0.0177, P=0.0023, P=0.0027, P<0.0001 and P=0.0164, respectively). In high- and intermediate-risk patients without lymph node metastasis, a greater number of lymph nodes were dissected when the extent of dissection was greater. Furthermore, the extent of PLND was a significantly associated with PSA failure. The results indicated that PLND exerted a therapeutic effect by eliminating microscopic pelvic lymph node metastases that were not detected by routine pathological examinations.
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Affiliation(s)
- Nobuki Furubayashi
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Takahito Negishi
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Tomoharu Uozumi
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Kouichi Shiraishi
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Kenichi Taguchi
- Department of Pathology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Mototsugu Shimokawa
- Institute for Clinical Research, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Motonobu Nakamura
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
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13
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Guo H, Kommidi H, Vedvyas Y, McCloskey JE, Zhang W, Chen N, Nurili F, Wu AP, Sayman HB, Akin O, Rodriguez EA, Aras O, Jin MM, Ting R. A Fluorescent, [ 18F]-Positron-Emitting Agent for Imaging Prostate-Specific Membrane Antigen Allows Genetic Reporting in Adoptively Transferred, Genetically Modified Cells. ACS Chem Biol 2019; 14:1449-1459. [PMID: 31120734 DOI: 10.1021/acschembio.9b00160] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Clinical trials involving genome-edited cells are growing in popularity, where CAR-T immunotherapy and CRISPR/Cas9 editing are more recognized strategies. Genetic reporters are needed to localize the molecular events inside these cells in patients. Specifically, a nonimmunogenic genetic reporter is urgently needed as current reporters are immunogenic due to derivation from nonhuman sources. Prostate-specific membrane antigen (PSMA) is potentially nonimmunogenic due to its natural, low-level expression in select tissues (self-MHC display). PSMA overexpression on human prostate adenocarcinoma is also visible with excellent contrast. We exploit these properties in a transduced, two-component, Human-Derived, Genetic, Positron-emitting, and Fluorescent (HD-GPF) reporter system. Mechanistically analogous to the luciferase and luciferin reporter, PSMA is genetically encoded into non-PSMA expressing 8505C cells and tracked with ACUPA-Cy3-BF3, a single, systemically injected small molecule that delivers positron emitting fluoride (18F) and a fluorophore (Cy3) to report on cells expressing PSMA. PSMA-lentivirus transduced tissues become visible by Cy3 fluorescence, [18F]-positron emission tomography (PET), and γ-scintillated biodistribution. HD-GPF fluorescence is visible at subcellular resolution, while a reduced PET background is achieved in vivo, due to rapid ACUPA-Cy3-BF3 renal excretion. Co-transduction with luciferase and GFP show specific advantages over popular genetic reporters in advanced murine models including, a "mosaic" model of solid-tumor intratumoral heterogeneity and a survival model for observing postsurgical recurrence. We report an advanced genetic reporter that tracks genetically modified cells in entire animals and with subcellular resolution with PET and fluorescence, respectively. This reporter system is potentially nonimmunogenic and will therefore be useful in human studies. PSMA is a biomarker of prostate adenocarcinoma and ACUPA-Cy3-BF3 potential in radical prostatectomy is demonstrated.
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Affiliation(s)
- Hua Guo
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medical College, New York, New York 10065, United States
| | - Harikrishna Kommidi
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medical College, New York, New York 10065, United States
| | - Yogindra Vedvyas
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medical College, New York, New York 10065, United States
| | - Jaclyn E. McCloskey
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medical College, New York, New York 10065, United States
| | - Weiqi Zhang
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medical College, New York, New York 10065, United States
| | - Nandi Chen
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medical College, New York, New York 10065, United States
- Department of Gastrointestinal Surgery, The Second Clinical Medicine College (Shenzhen People’s Hospital) of Jinan University, Shenzhen, Guangdong 518020, China
| | - Fuad Nurili
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, United States
| | - Amy P. Wu
- Department of Otolaryngology, Head & Neck Surgery, Northwell Health, Hofstra Northwell School of Medicine, Hempstead, New York 11549, United States
| | - Haluk B. Sayman
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul 34303, Turkey
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, United States
| | - Erik A. Rodriguez
- Department of Chemistry, The George Washington University, Washington, D.C. 20052, United States
| | - Omer Aras
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, United States
| | - Moonsoo M. Jin
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medical College, New York, New York 10065, United States
| | - Richard Ting
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medical College, New York, New York 10065, United States
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14
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Cacciamani GE, Porcaro AB, Sebben M, Tafuri A, Rizzetto R, De Luyk N, Ciocchetta E, Processali T, Pirozzi M, Amigoni N, Corsi P, Brunelli M, De Marco V, Artibani W. Extended pelvic lymphadenectomy for prostate cancer: should the Cloquet's nodes dissection be considered only an option? MINERVA UROL NEFROL 2019; 71:136-145. [DOI: 10.23736/s0393-2249.19.03342-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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van Leeuwen FWB, Winter A, van Der Poel HG, Eiber M, Suardi N, Graefen M, Wawroschek F, Maurer T. Technologies for image-guided surgery for managing lymphatic metastases in prostate cancer. Nat Rev Urol 2019; 16:159-171. [DOI: 10.1038/s41585-018-0140-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Muteganya R, Goldman S, Aoun F, Roumeguère T, Albisinni S. Current Imaging Techniques for Lymph Node Staging in Prostate Cancer: A Review. Front Surg 2018; 5:74. [PMID: 30581819 PMCID: PMC6293868 DOI: 10.3389/fsurg.2018.00074] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/19/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction: Lymph node metastases (LNM) represent a proven prognostic factor for biochemical recurrence (BCR)-free survival, metastatic free survival and overall survival in prostate cancer (PCa). Although pelvic node dissection remains the gold standard for the detection of LNM, novel imaging techniques are entering clinical practice, in the effort to improve LNM detection and spare unnecessary surgeries. Aim of the current review is to describe such imaging techniques and explore their advantages and limitations. Evidence Acquisition: The National Library of Medicine Database was searched for relevant articles published between January 2013 and August 2018. A wide search was performed including the combination of following words: “Prostate” and “Cancer” and “staging” and “Lymph Node” and “imaging” and (“MRI” or “PET”). The initial list of selected papers was enriched by individual suggestions of the authors of the present review. Evidence Synthesis: DWI-MRI in detection of lymph node invasion has a sensitivity and specificity of 41 and 94%, respectively. For SPIO MRI using ferumoxtran-10, the sensitivity for detection of LNM with short axis diameter of 5–10 mm is reported at 96.4%, compared to 28.5% with MRI alone. PSMA PET/CT is growing exponentially, both in the initial detection of LNM and for BCR evaluation. Fluciclovine PET could improve detection of subcentimetric pathologic lymph nodes. Sentinel lymph node techniques remain experimental and not validated in the field of PCa. Conclusions: Molecular imaging, particularly PSMA ligand PET imaging, present interesting diagnostic accuracy in LN diagnosis even in subcentimetric LN. DWI-MRI yields good results in LN involvement evaluation and the use of contrast agent such SPIO may improve the detection rate. The SLN technique is limited to experimental protocols and for intermediate or high-risk PCa. Prospective trials are awaited to evaluate the true clinical impact of these imaging techniques on PCa oncologic outcomes.
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Affiliation(s)
- Raoul Muteganya
- Department of Nuclear Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Goldman
- Department of Nuclear Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Fouad Aoun
- Urology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.,Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beyrouth, Lebanon
| | - Thierry Roumeguère
- Urology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Urology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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17
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Qiu S, Zeng J, Hou Y, Chen L, Ge J, Wen L, Liu C, Zhang Y, Zhu R, Gao M. Detection of lymph node metastasis with near-infrared upconversion luminescent nanoprobes. NANOSCALE 2018; 10:21772-21781. [PMID: 30452038 DOI: 10.1039/c8nr05811c] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The detection of lymph node metastasis is of great importance for therapy planning and prognosis of cancers, but remains challenging in the clinic. In the current study, we report a tumor-specific imaging probe constructed with NaGdF4:Yb,Tm,Ca@NaLuF4 core@shell upconversion nanoparticles showing distinctive near infrared emission. The following studies revealed that the characteristic Tm dopant emission at 804 nm showed a penetration depth up to 7.7 mm through multi-layered mice skin tissues, substantially greater than emissions at 655 nm and 541 nm typically from the widely used Er dopant, which is apparently favorable for sensitive tumor diagnosis. The cell binding assay further revealed that the anti-HER2 antibodies covalently attached on the particle surface endowed the nanoprobe with excellent binding specificity in targeting HER2-positive cancer cells in vitro, which further enabled the detection of lymph node metastasis of breast cancer in vivo in mice. In addition, the pharmacokinetics of the resulting nanoprobes were intensively studied through both upconversion luminescence imaging and SPECT imaging for comparing with that of the mother particles. The results obtained through both approaches were well consistent and revealed that the surface conjugation of antibodies largely altered the pharmacokinetic behaviors and substantially prolonged the blood half-life of the underlying nanoparticles, which was never reported before.
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Affiliation(s)
- Shanshan Qiu
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, 215123, China.
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18
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van Manen L, Handgraaf HJM, Diana M, Dijkstra J, Ishizawa T, Vahrmeijer AL, Mieog JSD. A practical guide for the use of indocyanine green and methylene blue in fluorescence-guided abdominal surgery. J Surg Oncol 2018; 118:283-300. [PMID: 29938401 PMCID: PMC6175214 DOI: 10.1002/jso.25105] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/21/2018] [Indexed: 12/14/2022]
Abstract
Near-infrared (NIR) fluorescence imaging is gaining clinical acceptance over the last years and has been used for detection of lymph nodes, several tumor types, vital structures and tissue perfusion. This review focuses on NIR fluorescence imaging with indocyanine green and methylene blue for different clinical applications in abdominal surgery with an emphasis on oncology, based on a systematic literature search. Furthermore, practical information on doses, injection times, and intraoperative use are provided.
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Affiliation(s)
- Labrinus van Manen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France.,Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Takeaki Ishizawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Jan Sven David Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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19
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Harke NN, Godes M, Wagner C, Addali M, Fangmeyer B, Urbanova K, Hadaschik B, Witt JH. Fluorescence-supported lymphography and extended pelvic lymph node dissection in robot-assisted radical prostatectomy: a prospective, randomized trial. World J Urol 2018; 36:1817-1823. [PMID: 29767326 DOI: 10.1007/s00345-018-2330-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/08/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To demonstrate the benefits of fluorescence-supported extended pelvic lymph node dissection (ePLND) compared to regular ePLND in robot-assisted radical prostatectomy. METHODS 120 patients with intermediate- or high-risk prostate cancer were prospectively randomized (1:1): in the intervention group, indocyanine green (ICG) was injected transrectally into the prostate before docking of the robot. In both groups, ePLND was performed including additional dissection of fluorescent lymph nodes (LN) in the ICG group. RESULTS After drop-out of two patients, 59 patients were allocated to the control (A) and intervention group (B) with a median PSA of 8,6 ng/ml. Median console time was 159 (A) vs. 168 (B) min (p = 0.20) with a longer time for ICG-ePLND: 43 (A) vs. 55 min (B) (p = 0.001). 2609 LN were found with significantly more LN after ICG-supported ePLND with a median of 25 vs. 17 LN in A (p < 0.001). Nodal metastases were detected in 6 patients in A (25 cancerous LN) vs. 9 patients in B (62 positive LN) (p = 0.40). In seven of nine patients, ICG-ePLND identified at least one cancer-positive LN (sensitivity 78%), 27 of 62 cancerous LN were fluorescent. Symptomatic lymphocele occurred in one patient in a and in three patients in b (p = 0.62). After a median follow-up of 22.9 months, PSA levels were similar. CONCLUSIONS While ICG-ePLND seems to be beneficial for a better understanding of the lymphatic drainage and a more meticulous diagnostic approach, the sensitivity is not sufficient to recommend stand-alone ICG lymph node dissection.
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Affiliation(s)
- Nina Natascha Harke
- Department of Urology, Urooncology and Pediatric Urology, Essen University Hospital, Hufelandstr. 55, 45147, Essen, Germany.
| | - Michael Godes
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Gronau, Germany
| | - Christian Wagner
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Gronau, Germany
| | - Mustapha Addali
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Gronau, Germany
| | - Bernhard Fangmeyer
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Gronau, Germany
| | - Katarina Urbanova
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Gronau, Germany
| | - Boris Hadaschik
- Department of Urology, Urooncology and Pediatric Urology, Essen University Hospital, Hufelandstr. 55, 45147, Essen, Germany
| | - Jorn H Witt
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Gronau, Germany
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20
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Miki J, Yanagisawa T, Tsuzuki S, Mori K, Urabe F, Kayano S, Yorozu T, Sato S, Kimura T, Takahashi H, Kishimoto K, Egawa S. Anatomical localization and clinical impact of sentinel lymph nodes based on patterns of pelvic lymphatic drainage in clinically localized prostate cancer. Prostate 2018; 78:419-425. [PMID: 29368339 DOI: 10.1002/pros.23486] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/03/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although sentinel lymph node in prostate has been generating renewed interest, its significance remains controversial due to inadequate evidence. METHODS We reviewed a prospective cohort of 50 consecutive patients with intermediate- to high-risk localized prostate cancer who had undergone laparoscopic radical prostatectomy. Sentinel lymph node biopsy by fluorescence detection using intraoperative imaging with indocyanine green and backup extended pelvic lymph node dissection were conducted prior to prostatectomy. Intraoperative and pathological findings were elaborated and compared for confirmation. RESULTS Sentinel lymph nodes were successfully identified in 47 patients (94%). A median of four sentinel lymph nodes was detected per patient. Lymph node metastasis was confirmed in six patients (12%), all of whom had positive sentinel lymph nodes. Three typical pathways of lymphatic drainage related to sentinel lymph nodes from the prostate were recognized. Ninety-one percent of the positive sentinel lymph nodes (10/11) were located at two predominant sites along these characteristic lymphatic pathways. One site was the junctional nodes, located at the junction between internal and external iliac vessels. The other was the distal internal iliac nodes, located along the inferior vesical artery. CONCLUSIONS Over 90% of positive sentinel lymph nodes were identified at two predominant sites. Priority should be given to the removal of these sentinel lymph nodes, which are located closer to the prostate, in pelvic lymph node dissection. Particular attention should be paid to identifying these nodes to reduce the possibility of overlooking lymph node metastasis.
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Affiliation(s)
- Jun Miki
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | | | - Shunsuke Tsuzuki
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Keiichiro Mori
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Fumihiko Urabe
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Sotaro Kayano
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Takashi Yorozu
- Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
| | - Shun Sato
- Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
| | - Koichi Kishimoto
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
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21
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Comparison of the diagnostic efficacy and perioperative outcomes of limited versus extended pelvic lymphadenectomy during robot-assisted radical prostatectomy: a multi-institutional retrospective study in Japan. Int J Clin Oncol 2017; 23:568-575. [DOI: 10.1007/s10147-017-1223-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
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22
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Gandaglia G, Zaffuto E, Fossati N, Bandini M, Suardi N, Mazzone E, Dell'Oglio P, Stabile A, Freschi M, Montorsi F, Briganti A. Identifying candidates for super-extended staging pelvic lymph node dissection among patients with high-risk prostate cancer. BJU Int 2017; 121:421-427. [PMID: 29063734 DOI: 10.1111/bju.14066] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess if the preoperative lymph node invasion (LNI) risk could be used to tailor the extent of pelvic lymph node dissection (PLND) according to individual profile in patients with prostate cancer (PCa) undergoing radical prostatectomy (RP), and to identify those who would benefit from the removal of the common iliac and pre-sacral nodes. PATIENTS AND METHODS A total of 471 patients with high-risk PCa treated with RP and a super-extended PLND that included the removal of the pre-sacral and common iliac nodes between 2006 and 2016 were identified. The risk of LNI was calculated according to the Briganti nomogram. Multivariable logistic regression analyses assessed the association between LNI risk and involvement of the common iliac and pre-sacral regions. The risk of positive common iliac and pre-sacral nodes was plotted over the LNI risk using the LOWESS-smoothed fit curve. RESULTS The median preoperative LNI risk was 25.5%. The median number of nodes removed was 23, and 171 (36.3%) patients had LNI. Overall, 61 (13.0%) and 28 patients (5.9%), respectively, had positive common iliac and pre-sacral nodes alone or in combination with other sites. The LNI risk was associated with the involvement of the common iliac and pre-sacral regions (all P < 0.001). The proportion of patients with positive common iliac and pre-sacral nodes progressively increased according to the LNI risk. The adoption of a 30% threshold would result in avoiding the removal of the common iliac and pre-sacral nodes in >60% cases, with a risk of missing LNI in these regions of <5%. CONCLUSIONS Fewer than 5% of patients with an LNI risk of <30% harbour positive common iliac and pre-sacral nodes. A super-extended PLND that includes the dissection of these regions should be considered exclusively in patients with an LNI risk ≥30%.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuele Zaffuto
- Unit of Urology/Division of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Unità Operativa Anatomia Patologica, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Nicola Fossati
- Unit of Urology/Division of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Bandini
- Unit of Urology/Division of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Nazareno Suardi
- Unit of Urology/Division of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Unit of Urology/Division of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Dell'Oglio
- Unit of Urology/Division of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Stabile
- Unit of Urology/Division of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Freschi
- Unità Operativa Anatomia Patologica, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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23
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Du J, Li Y, Wang Q, Batchu N, Zou J, Sun C, Lv S, Song Q, Li Q. Sentinel lymph node mapping in gynecological oncology. Oncol Lett 2017; 14:7669-7675. [PMID: 29344213 PMCID: PMC5755034 DOI: 10.3892/ol.2017.7219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/18/2017] [Indexed: 01/02/2023] Open
Abstract
The intraoperative mapping of sentinel lymph nodes (SLNs) is part of the treatment strategy for a number of types of tumor. To retrospectively compare results from the mapping of pelvic SLNs for gynecological oncology, using distinct dyes, the present review was conducted to determine the clinical significance of SLN mapping for gynecological oncology. In addition, the present study aimed at identifying an improved choice for SLN mapping tracers in clinical application. Each dye exhibits demerits when applied in the clinical environment. The combination of radioisotopes and blue dyes was identified to exhibit the most accurate detection rate of SLN drainage of gynecological oncology. However, contrast agents were unable to identify whether a SLN is positive or negative for metastasis prior to pathologic examination; additional studies are required.
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Affiliation(s)
- Jiang Du
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yaling Li
- Gongzhuling Health Workers High School, Gongzhuling, Jilin 136100, P.R. China
| | - Qing Wang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Nasra Batchu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Junkai Zou
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Chao Sun
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Shulan Lv
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Qing Song
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia 30310, USA.,Big Data Center, First Affiliated Hospital, Xi'an Jiatong University, Xi'an, Shaanxi 710061, P.R. China
| | - Qiling Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,Big Data Center, First Affiliated Hospital, Xi'an Jiatong University, Xi'an, Shaanxi 710061, P.R. China
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Xia L, Zeh R, Mizelle J, Newton A, Predina J, Nie S, Singhal S, Guzzo TJ. Near-infrared Intraoperative Molecular Imaging Can Identify Metastatic Lymph Nodes in Prostate Cancer. Urology 2017; 106:133-138. [PMID: 28438626 PMCID: PMC11090243 DOI: 10.1016/j.urology.2017.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 02/09/2017] [Accepted: 04/12/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To propose a novel method to perform indocyanine green (ICG) based near-infrared (NIR) fluorescence imaging during pelvic lymph node dissection (PLND) for prostate cancer patients with lymph node metastasis (LNM). MATERIALS AND METHODS A prostate cancer cell line PC3 was used to establish xenograft model in NOD/SCID mice. After tumor growth, the mice were injected with ICG through the tail vein. Xenografts and surrounding tissues were imaged with NIR camera 24 hours after intravenous ICG, and tumor-to-background ratios were calculated. We then performed a pilot human study to evaluate the role of NIR imaging in robotic PLND after systemic ICG in 4 patients with prostate cancer and preoperative lymphadenopathy. RESULTS ICG localized to PC3 xenografts in the mice and all xenografts were highly fluorescent compared with surrounding tissues, with a median tumor-to-background ratio of 2.85 (interquartile range = 2.64-3.90). In the human study, intraoperative in vivo NIR imaging identified 3 of the 4 preoperative lymphadenopathies as fluorescence-positive, and back table ex vivo NIR imaging identified all 4 lymphadenopathies as fluorescence-positive. All the lymphadenopathies were found to be LNMs by pathologic examination. Two of the four cases had additional LNMs, all of which were fluorescence-positive with intraoperative in vivo NIR imaging. CONCLUSION Intravenously administered ICG accumulates in prostate cancers in both a murine model and human patients. NIR fluorescence based on intravenous ICG may serve as a useful tool to facilitate the identification of positive nodes during PLND in patients with higher risk of LNMs.
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Affiliation(s)
- Leilei Xia
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ryan Zeh
- Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jack Mizelle
- Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Division of Thoracic Surgery and Thoracic Surgery Research Laboratory, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Andrew Newton
- Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Division of Thoracic Surgery and Thoracic Surgery Research Laboratory, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jarrod Predina
- Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Division of Thoracic Surgery and Thoracic Surgery Research Laboratory, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Shuming Nie
- Department of Biomedical Engineering, Emory University, Atlanta, GA
| | - Sunil Singhal
- Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Division of Thoracic Surgery and Thoracic Surgery Research Laboratory, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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Chang CK, Wu CJ, Chen CY, Wang CY, Chu TS, Hsu KF, Chiu HT, Liu HH, Chou CY, Wang CH, Lin CT, Dai NT, Tzeng YS. Intraoperative indocyanine green fluorescent angiography-assisted modified superior gluteal artery perforator flap for reconstruction of sacral pressure sores. Int Wound J 2017; 14:1170-1174. [PMID: 28736958 DOI: 10.1111/iwj.12781] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/31/2017] [Indexed: 12/19/2022] Open
Abstract
Pressure sores are often observed in patients who are bedridden. They can be a severe problem not only for patients and their caregivers but also for plastic surgeons. Here, we describe a new method of superior gluteal artery perforator flap harvesting and anchoring with the assistance of intraoperative indocyanine green fluorescent angiography. In this report, we describe the procedure and outcomes for 19 patients with grades III and IV sacral pressure sores who underwent the operation between September 2015 and November 2016. All flaps survived, and two experienced wound-edge partial dehiscence. With the assistance of this imaging device, we were able to acquire a reliable superior gluteal artery perforator flap and perform modified operations with it that are safe, easy to learn and associated with fewer complications than are traditional.
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Affiliation(s)
- Chun-Kai Chang
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Surgery, Zouying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chien-Ju Wu
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Yu Chen
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Yu Wang
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tzi-Shiang Chu
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Feng Hsu
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Han-Ting Chiu
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Hui Liu
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Yi Chou
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hsin Wang
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Ta Lin
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Niann-Tzyy Dai
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Near-infrared fluorescence with indocyanine green for diagnostics in urology: initial experience. Urologia 2017; 84:197-202. [PMID: 28525664 DOI: 10.5301/uj.5000235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Fluorescence imaging with indocyanine green is used in urology for the detection of sentinel lymph nodes and identification of prostate margins in radical prostatectomy for delineation of resection zone and selective clamping of vessels in partial nephrectomy; for identification and evaluation of length of ureteral strictures; for assessment of perfusion and viability of anastomoses during reconstructive stage of cystectomy. Safety of this technique is proven, while its diagnostic value and usefulness is still controversial. METHODS This pilot study of using the SPY Elite Fluorescence Imaging System for diagnostics was performed in the I.M. Sechenov First Moscow State Medical University. Ten patients were enrolled: four patients underwent retropubic RP and lymph node dissection, five patients underwent partial nephrectomy, and one patient underwent ureteroplasty. Fluorophore was injected transrectally with TRUS guidance during RP in order to assess the lymph nodes. During partial nephrectomy, the compound was injected intravenously to differentiate the tumor from parenchyma by its blood supply. During ureteroplasty, the indocyanine green solution was injected into the renal pelvis to dye the ureter and locate the stricture. RESULTS Sensitivity of this technique for visualization of sentinel lymph nodes was 100%, and specificity was 73.3%. In patients who underwent partial nephrectomy, all lesions were malignant and hypofluorescent when compared with healthy parenchyma. SPY allowed us to determine the location and extension of the stricture during ureteroplasty. No hypersensitivity reactions or complications were observed during injection of the compound.
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Wit EM, Acar C, Grivas N, Yuan C, Horenblas S, Liedberg F, Valdes Olmos RA, van Leeuwen FW, van den Berg NS, Winter A, Wawroschek F, Hruby S, Janetschek G, Vidal-Sicart S, MacLennan S, Lam TB, van der Poel HG. Sentinel Node Procedure in Prostate Cancer: A Systematic Review to Assess Diagnostic Accuracy. Eur Urol 2017; 71:596-605. [DOI: 10.1016/j.eururo.2016.09.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/02/2016] [Indexed: 01/08/2023]
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Pogue BW, Paulsen KD, Samkoe KS, Elliott JT, Hasan T, Strong TV, Draney DR, Feldwisch J. Vision 20/20: Molecular-guided surgical oncology based upon tumor metabolism or immunologic phenotype: Technological pathways for point of care imaging and intervention. Med Phys 2017; 43:3143-3156. [PMID: 27277060 DOI: 10.1118/1.4951732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Surgical guidance with fluorescence has been demonstrated in individual clinical trials for decades, but the scientific and commercial conditions exist today for a dramatic increase in clinical value. In the past decade, increased use of indocyanine green based visualization of vascular flow, biliary function, and tissue perfusion has spawned a robust growth in commercial systems that have near-infrared emission imaging and video display capabilities. This recent history combined with major preclinical innovations in fluorescent-labeled molecular probes, has the potential for a shift in surgical practice toward resection guidance based upon molecular information in addition to conventional visual and palpable cues. Most surgical subspecialties already have treatment management decisions partially based upon the immunohistochemical phenotype of the cancer, as assessed from molecular pathology of the biopsy tissue. This phenotyping can inform the surgical resection process by spatial mapping of these features. Further integration of the diagnostic and therapeutic value of tumor metabolism sensing molecules or immune binding agents directly into the surgical process can help this field mature. Maximal value to the patient would come from identifying the spatial patterns of molecular expression in vivo that are well known to exist. However, as each molecular agent is advanced into trials, the performance of the imaging system can have a critical impact on the success. For example, use of pre-existing commercial imaging systems are not well suited to image receptor targeted fluorophores because of the lower concentrations expected, requiring orders of magnitude more sensitivity. Additionally the imaging system needs the appropriate dynamic range and image processing features to view molecular probes or therapeutics that may have nonspecific uptake or pharmacokinetic issues which lead to limitations in contrast. Imaging systems need to be chosen based upon objective performance criteria, and issues around calibration, validation, and interpretation need to be established before a clinical trial starts. Finally, as early phase trials become more established, the costs associated with failures can be crippling to the field, and so judicious use of phase 0 trials with microdose levels of agents is one viable paradigm to help the field advance, but this places high sensitivity requirements on the imaging systems used. Molecular-guided surgery has truly transformative potential, and several key challenges are outlined here with the goal of seeing efficient advancement with ideal choices. The focus of this vision 20/20 paper is on the technological aspects that are needed to be paired with these agents.
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Affiliation(s)
- Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755 and Department of Surgery, Dartmouth College, Hanover, New Hampshire 03755
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755; Department of Surgery, Dartmouth College, Hanover, New Hampshire 03755; and Department of Diagnostic Radiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire 03755
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755 and Department of Surgery, Dartmouth College, Hanover, New Hampshire 03755
| | - Jonathan T Elliott
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114 and Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Theresa V Strong
- Vector Production Facility, Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294
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Munbauhal G, Seisen T, Gomez FD, Peyronnet B, Cussenot O, Shariat SF, Rouprêt M. Current perspectives of sentinel lymph node dissection at the time of radical surgery for prostate cancer. Cancer Treat Rev 2016; 50:228-239. [DOI: 10.1016/j.ctrv.2016.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 11/15/2022]
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Ramírez-Backhaus M, Mira Moreno A, Gómez Ferrer A, Calatrava Fons A, Casanova J, Solsona Narbón E, Ortiz Rodríguez IM, Rubio Briones J. Indocyanine Green Guided Pelvic Lymph Node Dissection: An Efficient Technique to Classify the Lymph Node Status of Patients with Prostate Cancer Who Underwent Radical Prostatectomy. J Urol 2016; 196:1429-1435. [PMID: 27235788 DOI: 10.1016/j.juro.2016.05.087] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE We evaluated the effectiveness of indocyanine green guided pelvic lymph node dissection for the optimal staging of prostate cancer and analyzed whether the technique could replace extended pelvic lymph node dissection. MATERIALS AND METHODS A solution of 25 mg indocyanine green in 5 ml sterile water was transperineally injected. Pelvic lymph node dissection was started with the indocyanine green stained nodes followed by extended pelvic lymph node dissection. Primary outcome measures were sensitivity, specificity, predictive value and likelihood ratio of a negative test of indocyanine green guided pelvic lymph node dissection. RESULTS A total of 84 patients with a median age of 63.55 years and a median prostate specific antigen of 8.48 ng/ml were included in the study. Of these patients 60.7% had intermediate risk disease and 25% had high or very high risk disease. A median of 7 indocyanine green stained nodes per patient was detected (range 2 to 18) with a median of 22 nodes excised during extended pelvic lymph node dissection. Lymph node metastasis was identified in 25 patients, 23 of whom had disease properly classified by indocyanine green guided pelvic lymph node dissection. The most frequent location of indocyanine green stained nodes was the proximal internal iliac artery followed by the fossa of Marcille. The negative predictive value was 96.7% and the likelihood ratio of a negative test was 8%. Overall 1,856 nodes were removed and 603 were stained indocyanine green. Pathological examination revealed 82 metastatic nodes, of which 60% were indocyanine green stained. The negative predictive value was 97.4% but the likelihood ratio of a negative test was 58.5%. CONCLUSIONS Indocyanine green guided pelvic lymph node dissection correctly staged 97% of cases. However, according to our data it cannot replace extended pelvic lymph node dissection. Nevertheless, its high negative predictive value could allow us to avoid extended pelvic lymph node dissection if we had an accurate intraoperative lymph fluorescent analysis.
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Affiliation(s)
| | - Alejandra Mira Moreno
- Department of Urology, Valencian Oncology Institute, FIVO, Almeria, Andalusia, Spain
| | - Alvaro Gómez Ferrer
- Department of Urology, Valencian Oncology Institute, FIVO, Almeria, Andalusia, Spain
| | | | - Juan Casanova
- Department of Urology, Valencian Oncology Institute, FIVO, Almeria, Andalusia, Spain
| | | | | | - José Rubio Briones
- Department of Urology, Valencian Oncology Institute, FIVO, Almeria, Andalusia, Spain
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31
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Nguyen DP, Huber PM, Metzger TA, Genitsch V, Schudel HH, Thalmann GN. A Specific Mapping Study Using Fluorescence Sentinel Lymph Node Detection in Patients with Intermediate- and High-risk Prostate Cancer Undergoing Extended Pelvic Lymph Node Dissection. Eur Urol 2016; 70:734-737. [PMID: 26856960 DOI: 10.1016/j.eururo.2016.01.034] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
Sentinel lymph node (SLN) detection techniques have the potential to change the standard of surgical care for patients with prostate cancer. We performed a lymphatic mapping study and determined the value of fluorescence SLN detection with indocyanine green (ICG) for the detection of lymph node metastases in intermediate- and high-risk patients undergoing radical prostatectomy and extended pelvic lymph node dissection. A total of 42 patients received systematic or specific ICG injections into the prostate base, the midportion, the apex, the left lobe, or the right lobe. We found (1) that external and internal iliac regions encompass the majority of SLNs, (2) that common iliac regions contain up to 22% of all SLNs, (3) that a prostatic lobe can drain into the contralateral group of pelvic lymph nodes, and (4) that the fossa of Marcille also receives significant drainage. Among the 12 patients who received systematic ICG injections, 5 (42%) had a total of 29 lymph node metastases. Of these, 16 nodes were ICG positive, yielding 55% sensitivity. The complex drainage pattern of the prostate and the low sensitivity of ICG for the detection of lymph node metastases reported in our study highlight the difficulties related to the implementation of SNL techniques in prostate cancer. PATIENT SUMMARY There is controversy about how extensive lymph node dissection (LND) should be during prostatectomy. We investigated the lymphatic drainage of the prostate and whether sentinel node fluorescence techniques would be useful to detect node metastases. We found that the drainage pattern is complex and that the sentinel node technique is not able to replace extended pelvic LND.
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Affiliation(s)
- Daniel P Nguyen
- Department of Urology, Bern University Hospital, Bern, Switzerland
| | - Philipp M Huber
- Department of Urology, Bern University Hospital, Bern, Switzerland
| | - Tobias A Metzger
- Department of Urology, Bern University Hospital, Bern, Switzerland
| | - Vera Genitsch
- Institute of Pathology, Bern University Hospital, Bern, Switzerland
| | - Hans H Schudel
- Department of Urology, Bern University Hospital, Bern, Switzerland
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Conti A, Santoni M, Burattini L, Scarpelli M, Mazzucchelli R, Galosi AB, Cheng L, Lopez-Beltran A, Briganti A, Montorsi F, Montironi R. Update on histopathological evaluation of lymphadenectomy specimens from prostate cancer patients. World J Urol 2015; 35:517-526. [PMID: 26694187 DOI: 10.1007/s00345-015-1752-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Metastases to lymph nodes (LNs) represent an unfavorable prognostic factor in patients with prostate cancer (PCa). Histological examination represents the gold standard in the evaluation of the lymphadenectomy (LND) specimens for the presence of secondary deposits. METHODS AND RESULTS The metastatic detection rate can vary according to the approach adopted in the microscopic analysis of the LNs, which includes frozen-section examination, total inclusion of the tissue with and without whole-mount sections, serial sectioning, and the application of immunohistochemistry. The assessment of the sentinel LN, the search for micrometastases, and the evaluation of atypical LN metastatic sites further contribute to the detection of the metastatic spread. CONCLUSION In this review, an update on the histopathological evaluation of LND specimens in patients with PCa is given, and focus is made on their clinical and prognostic significance.
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Affiliation(s)
- Alessandro Conti
- Department of Odontostomatologic and Specialized Clinical Sciences, Section of Urology, Marche Polytechnic University, School of Medicine, via Conca 71, 60126, Ancona, Italy
| | - Matteo Santoni
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, via Conca 71, 60126, Ancona, Italy
| | - Luciano Burattini
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, via Conca 71, 60126, Ancona, Italy
| | - Marina Scarpelli
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, AOU Ospedali Riuniti, via Conca 71, 60126, Torrette, Ancona, Italy
| | - Roberta Mazzucchelli
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, AOU Ospedali Riuniti, via Conca 71, 60126, Torrette, Ancona, Italy
| | - Andrea B Galosi
- Department of Odontostomatologic and Specialized Clinical Sciences, Section of Urology, Marche Polytechnic University, School of Medicine, via Conca 71, 60126, Ancona, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, AOU Ospedali Riuniti, via Conca 71, 60126, Torrette, Ancona, Italy.
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Siraj N, El-Zahab B, Hamdan S, Karam TE, Haber LH, Li M, Fakayode SO, Das S, Valle B, Strongin RM, Patonay G, Sintim HO, Baker GA, Powe A, Lowry M, Karolin JO, Geddes CD, Warner IM. Fluorescence, Phosphorescence, and Chemiluminescence. Anal Chem 2015; 88:170-202. [PMID: 26575092 DOI: 10.1021/acs.analchem.5b04109] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Noureen Siraj
- Department of Chemistry, Louisiana State University , Baton Rouge, Louisiana 70803, United States
| | - Bilal El-Zahab
- Department of Mechanical and Materials Engineering, Florida International University , Miami, Florida 33174, United States
| | - Suzana Hamdan
- Department of Chemistry, Louisiana State University , Baton Rouge, Louisiana 70803, United States
| | - Tony E Karam
- Department of Chemistry, Louisiana State University , Baton Rouge, Louisiana 70803, United States
| | - Louis H Haber
- Department of Chemistry, Louisiana State University , Baton Rouge, Louisiana 70803, United States
| | - Min Li
- Process Development Center, Albemarle Corporation , Baton Rouge, Louisiana 70805, United States
| | - Sayo O Fakayode
- Department of Chemistry, Winston-Salem State University , Winston-Salem, North Carolina 27110, United States
| | - Susmita Das
- Department of Civil Engineering, Adamas Institute of Technology , Barasat, Kolkata 700126, West Bengal India
| | - Bertha Valle
- Department of Chemistry, Texas Southern University , Houston, Texas 77004, United States
| | - Robert M Strongin
- Department of Chemistry, Portland State University , Portland, Oregon 97207, United States
| | - Gabor Patonay
- Department of Chemistry, Georgia State University , Atlanta, Georgia 30302-4098, United States
| | - Herman O Sintim
- Department of Chemistry and Biochemistry, University of Maryland , College Park, Maryland 20742, United States
| | - Gary A Baker
- Department of Chemistry, University of Missouri Columbia , Columbia, Missouri 65211-7600, United States
| | - Aleeta Powe
- Department of Chemistry, University of Louisville , Louisville, Kentucky 40208, United States
| | - Mark Lowry
- Department of Chemistry, Portland State University , Portland, Oregon 97207, United States
| | - Jan O Karolin
- Institute of Fluorescence, University of Maryland Baltimore County , Baltimore, Maryland 21202, United States
| | - Chris D Geddes
- Institute of Fluorescence, University of Maryland Baltimore County , Baltimore, Maryland 21202, United States
| | - Isiah M Warner
- Department of Chemistry, Louisiana State University , Baton Rouge, Louisiana 70803, United States
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Sonn GA, Behesnilian AS, Jiang ZK, Zettlitz KA, Lepin EJ, Bentolila LA, Knowles SM, Lawrence D, Wu AM, Reiter RE. Fluorescent Image-Guided Surgery with an Anti-Prostate Stem Cell Antigen (PSCA) Diabody Enables Targeted Resection of Mouse Prostate Cancer Xenografts in Real Time. Clin Cancer Res 2015; 22:1403-12. [PMID: 26490315 DOI: 10.1158/1078-0432.ccr-15-0503] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 10/06/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE The inability to visualize cancer during prostatectomy contributes to positive margins, cancer recurrence, and surgical side effects. A molecularly targeted fluorescent probe offers the potential for real-time intraoperative imaging. The goal of this study was to develop a probe for image-guided prostate cancer surgery. EXPERIMENTAL DESIGN An antibody fragment (cys-diabody, cDb) against prostate stem cell antigen (PSCA) was conjugated to a far-red fluorophore, Cy5. The integrity and binding of the probe to PSCA was confirmed by gel electrophoresis, size exclusion, and flow cytometry, respectively. Subcutaneous models of PSCA-expressing xenografts were used to assess the biodistribution and in vivo kinetics, whereas an invasive intramuscular model was utilized to explore the performance of Cy5-cDb-mediated fluorescence guidance in representative surgical scenarios. Finally, a prospective, randomized study comparing surgical resection with and without fluorescent guidance was performed to determine whether this probe could reduce the incidence of positive margins. RESULTS Cy5-cDb demonstrated excellent purity, stability, and specific binding to PSCA. In vivo imaging showed maximal signal-to-background ratios at 6 hours. In mice carrying PSCA(+) and negative (-) dual xenografts, the mean fluorescence ratio of PSCA(+/-) tumors was 4.4:1. In surgical resection experiments, residual tumors <1 mm that were missed on white light surgery were identified and resected using fluorescence guidance, which reduced the incidence of positive surgical margins (0/8) compared with white light surgery alone (7/7). CONCLUSIONS Fluorescently labeled cDb enables real-time in vivo imaging of prostate cancer xenografts in mice, and facilitates more complete tumor removal than conventional white light surgery alone.
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Affiliation(s)
- Geoffrey A Sonn
- Department of Urology, University of California, Los Angeles, California
| | | | - Ziyue Karen Jiang
- Department of Urology, University of California, Los Angeles, California
| | - Kirstin A Zettlitz
- Molecular and Medical Pharmacology, University of California, Los Angeles, California. Crump Institute for Molecular Imaging, University of California, Los Angeles, California
| | - Eric J Lepin
- Molecular and Medical Pharmacology, University of California, Los Angeles, California. Crump Institute for Molecular Imaging, University of California, Los Angeles, California
| | - Laurent A Bentolila
- Deparment of Chemistry and Biochemistry, University of California, Los Angeles, California. California NanoSystems Institute, University of California, Los Angeles, California
| | - Scott M Knowles
- Molecular and Medical Pharmacology, University of California, Los Angeles, California. Crump Institute for Molecular Imaging, University of California, Los Angeles, California
| | - Daniel Lawrence
- Molecular and Medical Pharmacology, University of California, Los Angeles, California
| | - Anna M Wu
- Molecular and Medical Pharmacology, University of California, Los Angeles, California. Crump Institute for Molecular Imaging, University of California, Los Angeles, California
| | - Robert E Reiter
- Department of Urology, University of California, Los Angeles, California.
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Re: Pretargeted dual-modality immuno-SPECT and near-infrared fluorescence imaging for image-guided surgery of prostate cancer. J Urol 2015; 193:2146-7. [PMID: 25986841 DOI: 10.1016/j.juro.2015.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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36
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Vilaseca A, Nguyen DP, Touijer KA. Should Fluorescence Mapping be Used to Guide Pelvic Lymph Node Dissection? J Urol 2015; 194:280-1. [PMID: 25986512 DOI: 10.1016/j.juro.2015.05.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Antoni Vilaseca
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel P Nguyen
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karim A Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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