Ferumoxtran-10 ultrasmall superparamagnetic iron oxide-enhanced diffusion-weighted imaging magnetic resonance imaging for detection of metastases in normal-sized lymph nodes in patients with bladder and prostate cancer: Do we enter the era after extended pelvic lymph node dissection?

摘要

With currently available imaging modalities like computed tomography (CT) and magnetic resonance imaging (MRI), it is a major challenge to find metastases in normal-sized lymph nodes (LNs). In prostate cancer, only 30% of LN metastases are detected, as most metastases are present in LNs <8 mm [1]. Routine pelvic lymph node dissection (PLND), currently the gold standard to determine LN status, also may fail to find small positive LNs (<41%) [2]. Missed nodes are an important reason for prostate-specific antigen (PSA) relapse after treatment with curative intent. Therefore, rather than using nodal imaging as a purely salvage strategy, we should also be looking at how better, preoperative LN staging changes management decisions.