Esther M K Wit1, Cenk Acar2, Nikolaos Grivas3, Cathy Yuan4, Simon Horenblas3, Fredrik Liedberg5, Renato A Valdes Olmos6, Fijs W B van Leeuwen6, Nynke S van den Berg6, Alexander Winter7, Friedhelm Wawroschek7, Stephan Hruby8, Günter Janetschek8, Sergi Vidal-Sicart9, Steven MacLennan4, Thomas B Lam10, Henk G van der Poel3. 1. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: e.wit@nki.nl. 2. Department of Urology, Eryaman Hospital, Ankara, Turkey. 3. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 4. Academic Urology Unit, University of Aberdeen, Aberdeen, UK. 5. Department of Urology, Skåne University Hospital Malmö and Department of Translational Medicine Lund University, Sweden. 6. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. 7. University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany. 8. Department of Urology, Paracelsus Medical University, Salzburg, Austria. 9. Department of Nuclear Medicine, Hospital Clinic Universitari de Barcelona, Barcelona, Spain. 10. Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
Abstract
CONTEXT: Extended pelvic lymph node dissection (ePLND) is the gold standard for detecting lymph node (LN) metastases in prostate cancer (PCa). The benefit of sentinel node biopsy (SNB), which is the first draining LN as assessed by imaging of locally injected tracers, remains controversial. OBJECTIVE: To assess the diagnostic accuracy of SNB in PCa. EVIDENCE ACQUISITION: A systematic literature search of Medline, Embase, and the Cochrane Library (1999-2016) was undertaken using PRISMA guidelines. All studies of SNB in men with PCa using PLND as reference standard were included. The primary outcomes were the nondiagnostic rate (NDR), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and false positive (FP) and false negative (FN) rates. Relevant sensitivity analyses based on SN definitions, ePLND as reference standard, and disease risk were undertaken, including a risk of bias (RoB) assessment. EVIDENCE SYNTHESIS: Of 373 articles identified, 21 studies recruiting a total of 2509 patients were eligible for inclusion. Median cumulative percentage (interquartile range) results were 4.1% (1.5-10.7%) for NDR, 95.2% (81.8-100%) for sensitivity, 100% (95.0-100%) for specificity, 100% (87.0-100%) for PPV, 98.0% (94.3-100%) for NPV, 0% (0-5.0%) for the FP rate, and 4.8% (0-18.2%) for the FN rate. The findings did not change significantly on sensitivity analyses. Most studies (17/22) had low RoB for index test and reference standard domains. CONCLUSIONS: SNB appears to have diagnostic accuracy comparable to ePLND, with high sensitivity, specificity, PPV and NPV, and a low FN rate. With a low FP rate (rate of detecting positive nodes outside the ePLND template), SNB may not have any additional diagnostic value over and above ePLND, although SNB appears to increase nodal yield by increasing the number of affected nodes when combined with ePLND. Thus, in high-risk disease it may be prudent to combine ePLND with SNB. PATIENT SUMMARY: This literature review showed a high diagnostic accuracy for sentinel node biopsy in detecting positive lymph nodes in prostate cancer, but further studies are needed to explore the effect of sentinel node biopsy on complications and oncologic outcome.
CONTEXT: Extended pelvic lymph node dissection (ePLND) is the gold standard for detecting lymph node (LN) metastases in prostate cancer (PCa). The benefit of sentinel node biopsy (SNB), which is the first draining LN as assessed by imaging of locally injected tracers, remains controversial. OBJECTIVE: To assess the diagnostic accuracy of SNB in PCa. EVIDENCE ACQUISITION: A systematic literature search of Medline, Embase, and the Cochrane Library (1999-2016) was undertaken using PRISMA guidelines. All studies of SNB in men with PCa using PLND as reference standard were included. The primary outcomes were the nondiagnostic rate (NDR), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and false positive (FP) and false negative (FN) rates. Relevant sensitivity analyses based on SN definitions, ePLND as reference standard, and disease risk were undertaken, including a risk of bias (RoB) assessment. EVIDENCE SYNTHESIS: Of 373 articles identified, 21 studies recruiting a total of 2509 patients were eligible for inclusion. Median cumulative percentage (interquartile range) results were 4.1% (1.5-10.7%) for NDR, 95.2% (81.8-100%) for sensitivity, 100% (95.0-100%) for specificity, 100% (87.0-100%) for PPV, 98.0% (94.3-100%) for NPV, 0% (0-5.0%) for the FP rate, and 4.8% (0-18.2%) for the FN rate. The findings did not change significantly on sensitivity analyses. Most studies (17/22) had low RoB for index test and reference standard domains. CONCLUSIONS: SNB appears to have diagnostic accuracy comparable to ePLND, with high sensitivity, specificity, PPV and NPV, and a low FN rate. With a low FP rate (rate of detecting positive nodes outside the ePLND template), SNB may not have any additional diagnostic value over and above ePLND, although SNB appears to increase nodal yield by increasing the number of affected nodes when combined with ePLND. Thus, in high-risk disease it may be prudent to combine ePLND with SNB. PATIENT SUMMARY: This literature review showed a high diagnostic accuracy for sentinel node biopsy in detecting positive lymph nodes in prostate cancer, but further studies are needed to explore the effect of sentinel node biopsy on complications and oncologic outcome.
Authors: Nikolaos Grivas; Esther Wit; Corinne Tillier; Erik van Muilekom; Floris Pos; Alexander Winter; Henk van der Poel Journal: Eur J Nucl Med Mol Imaging Date: 2017-08-05 Impact factor: 9.236
Authors: Nina Natascha Harke; Michael Godes; Christian Wagner; Mustapha Addali; Bernhard Fangmeyer; Katarina Urbanova; Boris Hadaschik; Jorn H Witt Journal: World J Urol Date: 2018-05-16 Impact factor: 4.226
Authors: Elio Mazzone; Paolo Dell'Oglio; Nikos Grivas; Esther Wit; Maarten Donswijk; Alberto Briganti; Fijs Van Leeuwen; Henk van der Poel Journal: J Nucl Med Date: 2021-02-05 Impact factor: 10.057
Authors: Alexander Winter; Thomas Kneib; Clara Wasylow; Lena Reinhardt; Rolf-Peter Henke; Svenja Engels; Holger Gerullis; Friedhelm Wawroschek Journal: J Cancer Date: 2017-08-22 Impact factor: 4.207
Authors: Girja S Shukla; Walter C Olson; Stephanie C Pero; Yu-Jing Sun; Chelsea L Carman; Craig L Slingluff; David N Krag Journal: J Transl Med Date: 2017-08-29 Impact factor: 5.531