Volume 53, Issue 1, Pages 118-125 (January 2008) The Template of the Primary Lymphatic Landing Sites of the Prostate Should Be Revisited: Results of a Multimodality Mapping Study  Agostino Mattei, Frank G. Fuechsel, Nivedita Bhatta Dhar, Sebastian H. Warncke, George N. Thalmann, Thomas Krause, Urs E. Studer  European Urology  Volume 53, Issue 1, Pages 118-125 (January 2008) DOI: 10.1016/j.eururo.2007.07.035 Copyright © 2007 European Association of Urology Terms and Conditions

Fig. 1 Regions of pelvic lymph node dissection. European Urology 2008 53, 118-125DOI: (10.1016/j.eururo.2007.07.035) Copyright © 2007 European Association of Urology Terms and Conditions

Fig. 2 Primary lymphatic landing sites of the prostate transferred from 3D datasets and superimposed into idealized anterior-posterior and medio-lateral projection of the pelvis (n=317 for 34 patients). All LNs depicted 3D reconstruction of single-photon emission computed tomography/computed tomography/magnetic resonance imaging (SPECT/CT/MRI) data sets and confirmed by surgery were subsequently transferred into a template projection of the pelvis. LNs are color coded in relation to the vascular structures and ureters. Superimposed are the boundaries of pelvic lymphadenectomy (PLND) subdivided into different regions. (a) Primary lymphatic landing sites of the prostate in anterior-posterior projection of the pelvis. (b) Primary lymphatic landing sites of the prostate in medio-lateral projections of the pelvis. Figs. (b)a. and (b)b. are reconstructions of the left and right hemipelvis, respectively, in the median view and therefore only the LNs of the left and right side are respectively shown. European Urology 2008 53, 118-125DOI: (10.1016/j.eururo.2007.07.035) Copyright © 2007 European Association of Urology Terms and Conditions

Fig. 3 Anatomical distribution of 317 lymph nodes of the prostate of all 34 patients based on single-photon emission computed tomography/computed tomography/magnetic resonance imaging (SPECT/CT/MRI) fusion imaging confirmed by surgery. European Urology 2008 53, 118-125DOI: (10.1016/j.eururo.2007.07.035) Copyright © 2007 European Association of Urology Terms and Conditions

Fig. 4 Anatomical extent of classical extended pelvic lymphadenectomy (PLND) (a) and of a proposed (new) extended PLND (b) for prostate cancer. (a) Area of classical extended template PLND for prostate cancer encompassing the nodes along the major pelvic vessels including the internal iliac, external iliac and obturator regions to the iliac bifurcation (yellow and orange areas). (b) Area of the proposed (new) extended template PLND extending along the common iliac vessels to the ureteric crossing (pale red area). European Urology 2008 53, 118-125DOI: (10.1016/j.eururo.2007.07.035) Copyright © 2007 European Association of Urology Terms and Conditions