Article Figures & Data
Figures
- FIGURE 1.
(A) Diagram of pelvis from inferolateral view. Bony-anatomy cutaway shows prostate (green, not to scale), bladder and urethra (yellow), and rectum (orange). (B) Inset shows needle insertion tracts, with arrows indicating sites of injection along these tracts.
- FIGURE 2.
Eight syringes, each containing 0.2 mL of 68Ga-iron oxide. First syringe to be used is attached to 22-gauge 150-mm Sprotte cannula.
- FIGURE 3.
Volume-rendered PET/CT (left and right) images and axial PET/CT (middle) images. After injection of tracer into prostate, imaging at 45 min demonstrated internal iliac SLN, inguinal SLN, and focal uptake at terminal thoracic duct near entry into left subclavian vein. No intervening SLN stations were seen in abdomen or chest. This intriguing finding correlates with increasing recognition of Virchow nodal metastases visualized with 68Ga-PSMA or 18F-choline PET.
- FIGURE 4.
After injection in prostate, left internal iliac SLN was identified. Additional drainage pathway from periprostatic region to inferior pubic ramus was observed and could represent drainage via periprostatic venous plexus rather than lymphatic pathway. Finding shows locoregional rather than hematogenous pathway of metastasis to pelvic bones and explains predominance of pelvic bony metastases in some patients.
Tables
SLNs Lymphatic drainage Patient Dose* (MBq) Scan 1 Scan 2 Second-echelon nodes Classic Aberrant Nonlymphatic SPECT 1 82.6 L external iliac, L common iliac L external iliac, L common iliac Retroperitoneal (paraaortic) Yes No No SPECT 2 31.0 R internal iliac R internal iliac, L internal iliac (probable) Yes No No SPECT 3 19.9 R external iliac R external iliac R common iliac Yes No No PET 1 16.1 R internal iliac, L perivesical, L internal iliac, L external iliac (probable) R internal iliac, L perivesical Yes Yes No PET 2 8.7 L internal iliac, L anterior periprostatic into L inferior pubic ramus L internal iliac, L anterior periprostatic into L inferior pubic ramus L internal iliac 2 Yes No Yes PET 3 21.0 L periprostatic L periprostatic, R periprostatic Yes No No PET 4 11.2 R mesorectal, L external iliac R mesorectal, L external iliac R presacral Yes Yes No PET 5 3.1 L internal iliac, L inguinal L internal iliac (disappears), L inguinal L common iliac, distal thoracic duct (Virchow node) Yes Yes No ↵* Injected dose of 99mTc-radiocolloid for SPECT and 68Ga-nanocolloid for PET.
SLNs were found both in classic sites of regional spread and in aberrant sites (boldface font). First 3 patients underwent 99mTc-radiocolloid SPECT/CT, and next 5 underwent 68Ga-nanocolloid PET/CT. Scans were obtained about 45 and 100 min after tracer injection.
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