A.A. Izmailov1, 2, A.B. Chaprak1, A.I. Garifullin1, A.R. Farganov1, A.R. Khaziev1, T.Kh. Akchulpan1, D.A. Kim1, A.G. Karimova1, Yu.N. Khrizman1, 2
1Republican Clinical Oncology Dispensary, Ufa
2Bashkir State Medical University, Ufa
Chaprak A.B. — oncologist of the Department of Onco-urology
73/1 Prospekt Oktyabrya, 450054 Ufa, Russian Federation, tel.: +7-999-120-26-96; e-mail: chap343@yandex.ru, ORCID ID: 0009-0008-3906-6521
Abstract. Prostate cancer is one of the most common malignancies in Russia and worldwide today. In 19–35% of cases with lymph node metastasis, areas beyond the obturator fossa are involved, so limited pelvic lymphadenectomy does not provide the necessary extent of lymph node removal. This necessitated the performance of extended lymphadenectomy. The risk of complications with this procedure reaches ≥15%. New methods for diagnosing lymph node involvement, such as sentinel lymph node biopsy, are currently actively developed.
Material and methods. The study included patients with localized high-risk and very high-risk prostate cancer who underwent radical prostatectomy, sentinel lymph node biopsy using the dual-detection method, and extended pelvic lymphadenectomy in the Onco-urology Department at Bashkortostan Republican Clinical Oncology Dispensary between August 2023 and June 2025. All sentinel lymph nodes were examined using the “bread-loaf” method with three sequential sections made every 750 µm.
Results. 56 patients were included in the analysis. Sentinel lymph nodes were identified in 100% of patients. Intraoperative assessment using the dual-detection method revealed sentinel lymph nodes in 53 patients (87.7%); in 3 patients, no lymph node staining was observed, and the sentinel lymph node was detected by a gamma probe. Forty-eight out of 56 patients (85.7%) were classified as pN0, while 8 (14.3%) had lymph node metastases. In 6 out of 8 patients, metastatic involvement was found only in the sentinel lymph nodes. Thus, the sensitivity, specificity, negative predictive value, and positive predictive value of the method for detecting lymph node metastases were 75, 100, 96, and 100% respectively.
Conclusion. Sentinel lymph node biopsy during prostatectomy is a promising diagnostic method with the potential to reduce the need for lymph node dissection. However, further studies are required to objectively assess its diagnostic significance and the comparative effectiveness of combined detection techniques. Univariate and multivariate analyses of prognostic parameters will be of particular importance, as they allow defining clear indications for SLNB and identifying groups of patients for whom this method may be most beneficial.
Key words: prostate cancer, pelvic lymphadenectomy, sentinel lymph node biopsy, radiopharmaceutical, indocyanine green.