Intraoperative imaging for sentinel node identification in prostate carcinoma: Its use in combination with other techniques

Abstract

We evaluated a portable γ-camera for sentinel node identification during laparoscopic sentinel lymphadenectomy for prostate cancer. Methods: We analyzed the portable γ-camera for intraoperative sentinel node visualization in 55 patients after 99mTc injection, preoperative planar lymphoscintigraphy, and SPECT/CT. Results: Sixteen percent of 178 nodes seen on SPECT/CT could not be detected with the portable γ-camera. A seed pointer was useful for localizing sentinel nodes intraoperatively in 27% of patients. Seventeen additional sentinel nodes (2 tumor-positive nodes) were removed by monitoring after excision. The location of each sentinel node was significantly associated with the ability to detect it intraoperatively. Conclusion: Intraoperative imaging leads to excision of more radioactive nodes and can determine the residual radioactivity after excision. The use of a radioactive source as a pointer enables efficient identification of nodes in difficult locations (paraaortic nodes) and in patients with a high body mass index. Copyright © 2011 by the Society of Nuclear Medicine, Inc.