Nynke S. Van Den Berg MSc, Presenter: Nothing to Disclose

Gijs Kleinjan MD, Abstract Co-Author: Nothing to Disclose

Oscar Brouwer, Abstract Co-Author: Nothing to Disclose

Cenk Acar, Abstract Co-Author: Nothing to Disclose

Esther Wit, Abstract Co-Author: Nothing to Disclose

Erik Vegt, Abstract Co-Author: Nothing to Disclose

Renato Valdes Olmos, Abstract Co-Author: Nothing to Disclose

Fijs Willon Bernard van Leeuwen PhD, Abstract Co-Author: Nothing to Disclose

Henk G. Van Der Poel, Abstract Co-Author: Nothing to Disclose

In 2011 the hybrid tracer indocyanine green (ICG)-99mTc-nanocolloid was introduced for sentinel node (SN) biopsy in prostate cancer patients. This tracer, being both radioactive and fluorescent, the radioguided approach was complemented with fluorescence guidance towards the SN(s). The current study evaluated how intraoperative fluorescence guidance during the hybrid SN procedure could be further optimized, by improving the tracer and by upgrading the fluorescence imaging hardware.

40 patients with >10% risk of lymph node metastasis (based on Briganti nomogram) were included for a combined SN, extended pelvic lymph node dissection (ePLND) and robot-assisted radical prostatectomy procedure. The hybrid tracer was injected into the peripheral zone of the prostate under transrectal ultrasound guidance. Following preoperative SN mapping (lymphoscintigraphy and SPECT/CT), intraoperative SN identification was achieved using radiotracing and fluorescence imaging. Three patient groups were evaluated: In group 1 (n=11) the “old” tracer formulation was used for injection combined with the intraoperative use of the Tricam SL II + D-light C system (KARL STORZ Endoskope). In group 2 (n=13), an increased particle concentration of the hybrid tracer was injected with reduced volume. In group 3 (n=16) the fluorescence laparoscope was upgraded to an Image HUB 1 HD + D-light P system (KARL STORZ).

Fluorescence-based SN identification increased from 64% in group 1 to 85% in group 2 and 93% in group 3 (p-value=0.004). On follow-up, there were fewer N0 patients with a R0 margin with biochemical recurrence (PSA>0.1 ng/mL) in group 3 (Fig. 1).

By introducing a new tracer formulation and new fluorescence imaging hardware, intraoperative fluorescence SN detection improved significantly. This contributes to the refinement of the SN procedure, which in turn may improve regional staging in prostate cancer patients.

Improved intraoperative SN identification may lead to improved regional lymph node staging prostate cancer patients, resulting in better patient-tailored therapy planning and possibly improved survival.

Van Den Berg, N, Kleinjan, G, Brouwer, O, Acar, C, Wit, E, Vegt, E, Valdes Olmos, R, van Leeuwen, F, Van Der Poel, H, Optimization of Fluorescence Detection Improves Sentinel Node Localization in Prostate Cancer Patients.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018610.html