Caroline Rousseau1,2, Thierry Rousseau3, Cédric Mathieu4, Jacques Lacoste3, Eric Potiron3, Geneviève Aillet5, Pierre Nevoux3, Georges Le Coguic3, Loïc Campion6,7, Françoise Kraeber-Bodéré4,6. 1. Nuclear Medicine Unit, ICO Gauducheau Cancer Center, Saint Herblain, France. caroline.rousseau@ico.unicancer.fr. 2. Nantes-Angers Cancer Research Center, INSERM U892, CNRS UMR 6299, University of Nantes, Nantes, France. caroline.rousseau@ico.unicancer.fr. 3. Urologic Clinic Nantes-Atlantis, Saint-Herblain, France. 4. Nuclear Medicine Unit, ICO Gauducheau Cancer Center, Saint Herblain, France. 5. Anatomopathology Unit, Institut d'Histopathologie, Nantes, France. 6. Nantes-Angers Cancer Research Center, INSERM U892, CNRS UMR 6299, University of Nantes, Nantes, France. 7. Statistics Unit, ICO Gauducheau Cancer Center, Saint Herblain, France.
Abstract
AIM: In intermediate- or high-risk prostate cancer (PC) patients, to avoid extended pelvic lymph node dissection (ePLND), the updated Briganti nomogram is recommended with the cost of missing 1.5 % of patients with lymph node invasion (LNI). Is it possible to reduce the percentage of unexpected LNI patients (nomogram false negative)? We used the isotopic sentinel lymph node (SLN) technique systematically associated with laparoscopic ePLND to assess the potential value of isotopic SLN method to adress this point. METHODS: Two hundred and two consecutive patients had procedures with isotopic SLN detection associated with laparoscopic ePLND for high or intermediate risk of PC. The area under the curve (AUC) of the receiver operating characteristics (ROC) analysis was used to quantify the accuracy of different models as: the updated Briganti nomogram, the percentage of positive cores, and an equation of the best predictors of LNI. We tested the model cutoffs associated with an optimal negative predictive value (NPV) and the best cutoff associated with avoiding false negative SLN detection, in order to assist the clinician's decision of when to spare ePLND. RESULTS: LNI was detected in 35 patients (17.2 %). Based on preoperative primary Gleason grade and percentage of positive cores, a bivariate model was built to calculate a combined score reflecting the risk of LNI. For the Briganti nomogram, the 5 % probability cutoff avoided ePLND in 53 % (108/202) of patients, missing three LNI patients (8.6 %), but all were detected by the SLN technique. For our bivariate model, the best cutoff was <10, leaving no patient with LNI due to positive SLN detection (four patients = 11.4 %), and avoiding ePLND in 52 % (105/202) of patients. CONCLUSION: For patients with a low risk of LNI determined using the updated Briganti nomogram or bivariate model, SLN technique could be used alone for lymph node staging in intermediate- or high-risk PC patients.
AIM: In intermediate- or high-risk prostate cancer (PC) patients, to avoid extended pelvic lymph node dissection (ePLND), the updated Briganti nomogram is recommended with the cost of missing 1.5 % of patients with lymph node invasion (LNI). Is it possible to reduce the percentage of unexpected LNI patients (nomogram false negative)? We used the isotopic sentinel lymph node (SLN) technique systematically associated with laparoscopic ePLND to assess the potential value of isotopic SLN method to adress this point. METHODS: Two hundred and two consecutive patients had procedures with isotopic SLN detection associated with laparoscopic ePLND for high or intermediate risk of PC. The area under the curve (AUC) of the receiver operating characteristics (ROC) analysis was used to quantify the accuracy of different models as: the updated Briganti nomogram, the percentage of positive cores, and an equation of the best predictors of LNI. We tested the model cutoffs associated with an optimal negative predictive value (NPV) and the best cutoff associated with avoiding false negative SLN detection, in order to assist the clinician's decision of when to spare ePLND. RESULTS: LNI was detected in 35 patients (17.2 %). Based on preoperative primary Gleason grade and percentage of positive cores, a bivariate model was built to calculate a combined score reflecting the risk of LNI. For the Briganti nomogram, the 5 % probability cutoff avoided ePLND in 53 % (108/202) of patients, missing three LNI patients (8.6 %), but all were detected by the SLN technique. For our bivariate model, the best cutoff was <10, leaving no patient with LNI due to positive SLN detection (four patients = 11.4 %), and avoiding ePLND in 52 % (105/202) of patients. CONCLUSION: For patients with a low risk of LNI determined using the updated Briganti nomogram or bivariate model, SLN technique could be used alone for lymph node staging in intermediate- or high-risk PC patients.
Authors: Cenk Acar; Gijs H Kleinjan; Nynke S van den Berg; Esther Mk Wit; Fijs Wb van Leeuwen; Henk G van der Poel Journal: Int J Urol Date: 2015-07-14 Impact factor: 3.369
Authors: Jens Hansen; Michael Rink; Marco Bianchi; Luis A Kluth; Zhe Tian; Sascha A Ahyai; Shahrokh F Shariat; Alberto Briganti; Thomas Steuber; Margit Fisch; Markus Graefen; Pierre I Karakiewicz; Felix K-H Chun Journal: Prostate Date: 2012-07-20 Impact factor: 4.104
Authors: T Rousseau; J Lacoste; A Pallardy; L Campion; B Bridji; A Mouaden; A Testard; G Aillet; G Le Coguic; E Potiron; C Curtet; F Kraeber-Bodéré; C Rousseau Journal: Prog Urol Date: 2011-07-23 Impact factor: 0.915
Authors: Alberto Briganti; Felix K-H Chun; Andrea Salonia; Nazareno Suardi; Andrea Gallina; Luigi Filippo Da Pozzo; Marco Roscigno; Giuseppe Zanni; Luc Valiquette; Patrizio Rigatti; Francesco Montorsi; Pierre I Karakiewicz Journal: Eur Urol Date: 2006-08-31 Impact factor: 20.096