Prostate cancer and prostatic diseases · 2025
Augmented Reality PSMA-3D guided robotic pelvic lymph node dissection (PLND) in prostate cancer patients.
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Bianchi L, Mottaran A, Bortolani B, Cercenelli L, Farolfi A, Scarlatti R, Piazza P, Ragni M, Droghetti M, Chessa F, Salvador M, Gaudiano C, Giunchi F, Barbagallo M, Borriello A, Fiorentino M, Castellucci P, Mosconi C, Marcelli E, Fanti S, Schiavina R, Brunocilla E
Аннотация
BACKGROUND AND OBJECTIVE: Intraoperative identification of suspicious lymph node metastases (LNM) detected at PSMA-PET is key to achieve optimal surgical outcomes of robot-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND). We aim to describe a novel technique of augmented reality (AR)-PSMA-3D guided PLND based on preoperative PSMA-PET for real-time identification of LNM.
METHODS: Thirteen patients with high-risk PCa and miN1-2 or miM1a disease at PSMA-PET were prospectively enrolled. 3D segmentation model including suspicious LNM was created from PSMA-PET images.
INTERVENTION: Patients underwent RARP with AR-PSMA-3D guided PLND for real-time intraoperative identification of suspicious LNM. Pathologic examination was used as reference standard.
KEY FINDINGS AND LIMITATIONS: Four (30%) men had suspicious LNM at PSMA-PET outside the field of the PLND template. The AR-PSMA-3D guided PLND allow to dissect each region with suspected LNM at PSMA-PET with no intraoperative complications. Nine (69%) patients had pN1 disease and three (23%) men had nodal metastases outside the PLND template. The sensitivity, specificity, PPV, NPV and AUC of AR-PSMA-3D guided PLND at a per-region analysis were 69%, 90%, 52%, 95% and 0.79, respectively.
LIMITATIONS: low spatial resolution of PSMA-PET for micro-metastases and the need for manual alignment of the 3D model.
CONCLUSIONS AND CLINICAL IMPLICATIONS: AR-PSMA-3D guidance for PLND in patients with miN1-N2-M1a disease at PSMA-PET allows to facilitate the resection of suspicious LNM including those outside the PLND template. We propose a novel technique combining AR and PSMA-PET 3D models to guide PLND during RARP in PCa patients. The AR-PSMA-3D guidance for PLND allows a promising real-time identification of suspicious nodes, even outside the PLND template.
METHODS: Thirteen patients with high-risk PCa and miN1-2 or miM1a disease at PSMA-PET were prospectively enrolled. 3D segmentation model including suspicious LNM was created from PSMA-PET images.
INTERVENTION: Patients underwent RARP with AR-PSMA-3D guided PLND for real-time intraoperative identification of suspicious LNM. Pathologic examination was used as reference standard.
KEY FINDINGS AND LIMITATIONS: Four (30%) men had suspicious LNM at PSMA-PET outside the field of the PLND template. The AR-PSMA-3D guided PLND allow to dissect each region with suspected LNM at PSMA-PET with no intraoperative complications. Nine (69%) patients had pN1 disease and three (23%) men had nodal metastases outside the PLND template. The sensitivity, specificity, PPV, NPV and AUC of AR-PSMA-3D guided PLND at a per-region analysis were 69%, 90%, 52%, 95% and 0.79, respectively.
LIMITATIONS: low spatial resolution of PSMA-PET for micro-metastases and the need for manual alignment of the 3D model.
CONCLUSIONS AND CLINICAL IMPLICATIONS: AR-PSMA-3D guidance for PLND in patients with miN1-N2-M1a disease at PSMA-PET allows to facilitate the resection of suspicious LNM including those outside the PLND template. We propose a novel technique combining AR and PSMA-PET 3D models to guide PLND during RARP in PCa patients. The AR-PSMA-3D guidance for PLND allows a promising real-time identification of suspicious nodes, even outside the PLND template.