Magnetische Detektion von Sentinel-Lymphknoten beim Prostatakarzinom nach intraprostatischer Injektion von superparamagnetischen Eisenoxid-Nanopartikeln

Zusammenfassung

Eine zuverlässige Information über den Lymphknotenstatus ist beim Prostatakarzinom für ein akkurates Staging bzw. eine hierauf abgestimmte optimale Therapieplanung von großer Bedeutung. Trotz deutlicher Fortschritte in der Bildgebung stellt der histologische Metastasennachweis bzw. die pelvine Lymphadenektomie (PLND) weiterhin das zuverlässigste Verfahren für das Lymphknotenstaging beim klinisch lokalisierten Prostatakarzinom dar, insbesondere wegen des möglichen Nachweises von kleinen bzw. Mikrometastasen. Die Radioisotop-gesteuerte Sentinel-PLND (sPLND) weist beim Prostatakarzinom eine hohe Sensitivität im Nachweis von Lymphknotenmetastasen und dabei aufgrund der zielgerichteten Entfernung von vergleichsweise wenigen Lymphknoten eine geringe Morbidität auf. Dem stehen jedoch bedingt durch die radioaktive Markierung prinzipielle Limitationen wie z. B. die einzuhaltenden strikten gesetzlichen Regularien, die Erfordernis einer Nuklearmedizin und die radioaktive Exposition von Patienten und medizinischem Personal gegenüber. Um die Vorteile des zielgerichteten Sentinel-Verfahrens weiter zu nutzen, aber die Nachteile der radioaktiven Markierung zu umgehen, wurde beim Mammakarzinom die Markierung von Sentinel-Lymphknoten (SLNs) mittels superparamagnetischen Eisenoxid-Nanopartikeln (SPIONs) überprüft und die Nichtunterlegenheit gegenüber der etablierten Markierung mittels ^99mTechnetium-Nanokolloid gezeigt. Wie ehemals die radioaktive Markierung konnte dieses innovative neue magnetische Markierungsverfahren und die intraoperative Identifizierung von SLNs mittels eines Hand-Magnetometers erfolgreich auf das Prostatakarzinom übertragen und in ersten Untersuchungen eine hohe Sensitivität in der Detektion Lymphknoten-positiver Patienten gezeigt werden. Dabei bietet die Methode außerdem den Vorteil, sicher und vergleichsweise einfach von einem Urologen alleine unabhängig durchgeführt werden zu können. Zudem kann die Visualisierung der SPION-markierten SLNs mittels Magnetresonanztomografie vergleichbar zur Lymphszintigraphie beim radioaktiven Verfahren eine präzise präoperative SLN-Identifizierung und damit eine vollständig strahlungsfreie prä- und intraoperative Identifikation der SLNs bei Patienten mit Prostatakarzinom ermöglichen.

Abstract

In prostate cancer, reliable information about the lymph node status is of great importance for accurate staging and the optimal planning of treatment. Despite recent advances in imaging, the histological detection of metastases, or pelvic lymphadenectomy (PLND), continues to be the most reliable method for lymph node staging in clinically localised prostate cancer, especially as this procedure enables the detection of small or micrometastases. Radioisotope-guided sentinel PLND (sPLND) demonstrates high sensitivity in the detection of lymph node metastases as well as low morbidity in prostate cancer because of the targeted removal of a relatively small number of lymph nodes. However, radioactive labelling is associated with limitations such as strict legal regulations, the need for a nuclear medicine department and the radioactive exposure of patients and medical staff. In order to take advantage of the targeted sentinel method while avoiding the disadvantages of radioactive labelling, the identification of sentinel lymph nodes (SLNs) by means of superparamagnetic iron oxide nanoparticles (SPIONs) was studied in breast carcinoma, and its non-inferiority compared with the established procedure with ^99mtechnetium nanocolloid was demonstrated. Just like the radioactive identification of SLNs, this innovative new method for magnetic labelling and the intraoperative identification of SLNs using a hand-held magnetometer were successfully transferred to prostate cancer. Initial studies demonstrated high sensitivity in the detection of lymph node-positive patients. This method offers the additional advantage of being safe and easy to perform for a single urologist. In addition, the visualisation of SPION-marked SLNs through magnetic resonance tomography enables a precise preoperative SLN identification comparable to lymphoscintigraphy in the radioactive approach. Therefore, SLNs can be identified before and during surgical procedures in prostate cancer patients without exposure to irradiation.

Schlüsselwörter

Prostatakarzinom - Sentinel-Lymphknoten - Lymphadenektomie - SPIONs - Magnetometer

Key words

prostate cancer - sentinel lymph node - lymphadenectomy - SPIONs - magnetometer

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