Sentinel Lymph Node Biopsy in Lymphadenectomy for Prostate Cancer

Performing the sentinel lymph node (SLN) biopsy during prostate cancer staging aims to provide more accurate nodal staging with low complications than pelvic lymph node dissection. SLN might be found outside the extended pelvic lymph node dissection template. Conventional SLN mapping is carried out after the injection of a 99mTc-based tracer and subsequent preoperative imaging; for example, lymphoscintigraphy and single photon emission computed tomography/computed tomography. This approach allowed the detection of SLNs outside the extended lymph node dissection template in 3.6-36% of men with intermediate-and high-risk prostate cancer. Hereby, an overall false negative rate of sentinel SLNs was reported between 0% and 24.4% in the studies. To further refine the intraoperative sampling procedure, novel imaging methods such as fluorescence imaging have been introduced. Prospective randomized comparison studies are required to confirm the added benefit of sentinel template directed nodal dissection. There is a need to find a consensus about the topics such as Injection procedure, preoperative imaging, intraoperative sampling and dissection for performing SLN biopsy.