De schildwachtklierprocedure bij prostaatkanker. Optimalisatie van de huidige methode.

Zeegers, L.L.G (Lisette) (2013) De schildwachtklierprocedure bij prostaatkanker. Optimalisatie van de huidige methode. thesis, Medicine.

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Abstract

Introduction: Knowledge of the tumor status of the lymph nodes is relevant for prognostic and therapeutic reasons. The extent of lymph node dissection remains topic of debate. Whereas some have argued that extensive nodal dissection is the best method to detect metastases, others favour sole excision of sentinel node. Extensive pelvine lymph nodal dissection (ePLND) is associated with high morbidity as lymphocele, oedema and venous thrombosis. It also misses tumor draining lymph nodes outside the extended field. Sentinel node biopsy (SNB) is associated with less morbidity than ePLND, but has not been fully validated. This study aimed to evaluate the added value of intraoperative fluorescence imaging to the radioguided SNB-procedure in patients with prostate cancer. Another aim was to study if there is a relationship between the injection site and the observed lymphatic drainage pattern. In the addendum the difference between the observed drainage pattern in an old and a new doses group is discussed. The new doses group contains more nanocolloid particels that can bind the fluorescence particle ICG. Materials en methods: The SNB starts with intraprostatic tracer injection. Preoperative sentinel node mapping is routinely performed with lymphoscintigraphy, followed by SPECT/CT. Intraoperatively, sentinel nodes are pursued with a gamma ray detection probe and a fluorescence laparoscope. Ex vivo, the fluorescence signal was determined in the prostate sections; the highest signal on the slides were correlated to the visualized drainage pattern on the preoperative images. In retrospect we also compared an old and a new doses group of patients (both n=33). The difference in visualized sentinel nodes and higher echelon nodes was analyzed with the Wilcoxin-test. Results: Preoperatively, SPECT/CT was able to identify 17 additional sentinel nodes, not seen on lymphoscintigraphy resulting in a total of 48 identified sentinel nodes. A total of 45 sentinel nodes were excised during surgery, of which 26% was detected by the fluorescence laparoscope. All sentinel nodes were both radioactive and fluorescence. Ex vivo, the highest fluorescence signal corresponded in 9 patients with equal better drainage on the same or both sides. Also, there is a trend in the new doses group, being that more sentinel nodes and higher echelon nodes were shown on the preoperative images compared to the old doses group (p=0.739). Conclusion and discussion: In 26% of the cases, fluorescence was of added value to detect the sentinel nodes during surgery. Ex vivo analysis of the prostate sections showed a trend in 60% of the patients, in whom a high fluorescence signal was associated with more drainage at the same side. In the remaining 40% there was no correlation. The population of this study is too little (n=15) to come up with a significant conclusion about the relationship between the injection location and the observed lymphatic drainage pattern. Therefore, further research is recommended. The fact there were not significant more sentinel nodes visualized in the new doses group can be explained by the fact that the new doses contains more particles, whilst the composition retains the same. This might lead to increased intensity of the sentinel nodes, but the present software is not sophisticated enough to come up with a conclusion in relation to this.

Item Type:	Thesis (Thesis)
Supervisor name:	Leenknegt, H.
Supervisor name:	Vegt, E. and Nederlands Kanker Instituut - Antoni van Leeuwenhoek Ziekenh and Afdeling Nucleaire Geneeskunde
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:45
Last Modified:	25 Jun 2020 10:45
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/605

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