Targeted pelvic lymph node dissection using magnetic resonance imaging - ultrasonography fusion technique and indocyanine green injection in robot-assisted radical prostatectomy.

This study assessed the diagnostic accuracy and potential therapeutic value in performing targeted pelvic lymph node dissection (PLND) guided by magnetic resonance imaging (MRI)-ultrasonography (US) fusion combined with Indocyanine green (ICG) injection (tPLND-MUI). This study was retrospectively designed and included 72 patients who underwent robotic radical prostatectomy (RARP) combined with PLND. The inclusion criteria were: (1) prostate cancer with a Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) category 4 or 5 lesion on MRI, (2) Patients who had clinical records of ICG fluorescence or surgical videos of PLND. The clinical impact of the tPLND-MUI was assessed based on its diagnostic accuracy for identifying nodal metastasis and its potential therapeutic value in achieving complete removal of metastatic lymph nodes. A backup PLND using the super-extended template (sePLND) was performed, and outcomes of tPLND-MUI, limited-PLND (limPLND), extended-PLND (ePLND), and standard-PLND (sPLND) were compared against sePLND. A total of 72 patients were incorporated into the final analysis. tPLND-MUI resulted in a median removal of 29 lymph nodes which were fewer than those of sePLND and ePLND. For detecting at least one lymph node metastasis, sensitivity reached 100% with both ePLND and tPLND-MUI, 95.2% with sPLND, and 71.4% with lim-PLND. The ratios of complete removal of lymph node metastases were 81.0% for ePLND, 66.7% for sPLND, 33.3% for limPLND, and 95.2% for tPLND-MUI. tPLND-MUI may demonstrate excellent therapeutic and diagnostic performance despite the removal of fewer lymph nodes and fewer dissecting regions. Further prospective research is needed to validate these findings.