Image-guided surgery is a standard of quality in certain specialties, however, the use of radiotracers in urological surgery, with the exception of penile cancer, has so far been anecdotal. The incorporation of diagnostic procedures based on molecular imaging (PET-CT, SPECT-CT, MRI, PET-MRI) improves diagnostic performance and can be used in the surgical planning of urological tumors, such as sentinel lymph node in prostate cancer, with the aim of reducing surgical time and morbidity of classic surgery, and possibly in the long term improving survival.
Radioguided surgery in urology reduces surgical time and, in the long term, improves survival.
When is sentinel node surgery indicated?
Sentinel node surgery is indicated in patients with intermediate high-risk prostate cancer who have a high probability of lymph node involvement and who were previously, in most cases, undergoing radiotherapy with hormone therapy. It is also a salvage surgery in patients who, after radical prostatectomy or radiotherapy, present a biochemical recurrence (elevated PSA) and who PET-CT and other radiological methods show exclusively nodal involvement.
What does the procedure consist of?
The day before surgery, Technetium-99 is injected into the prostate for the SPECT-CT scan, which will identify and locate the sentinel lymph nodes and allow surgical planning. For intraoperative identification, a probe adapted to the laparoscopic surgical field and an external navigator (Sentinella®) are used to locate the sentinel nodes, including those located outside the usual drainage territories, to evaluate the extracorporeal activity of the resected sentinel nodes and the absence of activity in the surgical bed, indicative of complete excision.
Future of radioguided surgery in urology?
The systematization and consolidation of radioguided prostate surgery is allowing its expansion to other pathologies such as renal and infiltrating bladder tumors. The future will determine whether these techniques are consolidated and generalized in routine practice.