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Laparoscopic sentinel lymph node dissection in prostate cancer patients: the additional value depends on preoperative data

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

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.

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Acknowledgments

This work has been supported by grants from the French National Agency for Research called Investissements d’Avenir, Labex IRON no. ANR-11-LABX-0018-01 and Equipex ArronaxPlus no. ANR-11-EQPX-0004.

The authors’ gratitude goes to the patients of the study, the nuclear medicine technologists at the ICO Cancer Center, N. Fleury (clinical research associate) and E. Cerato (Project manager).

Author information

Authors and Affiliations

  1. Nuclear Medicine Unit, ICO Gauducheau Cancer Center, Saint Herblain, France

    Caroline Rousseau, Cédric Mathieu & Françoise Kraeber-Bodéré

  2. Nantes-Angers Cancer Research Center, INSERM U892, CNRS UMR 6299, University of Nantes, Nantes, France

    Caroline Rousseau, Loïc Campion & Françoise Kraeber-Bodéré

  3. Urologic Clinic Nantes-Atlantis, Saint-Herblain, France

    Thierry Rousseau, Jacques Lacoste, Eric Potiron, Pierre Nevoux & Georges Le Coguic

  4. Anatomopathology Unit, Institut d’Histopathologie, Nantes, France

    Geneviève Aillet

  5. Statistics Unit, ICO Gauducheau Cancer Center, Saint Herblain, France

    Loïc Campion

Authors
  1. Caroline Rousseau
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  2. Thierry Rousseau
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  3. Cédric Mathieu
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  4. Jacques Lacoste
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  5. Eric Potiron
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  6. Geneviève Aillet
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  7. Pierre Nevoux
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  8. Georges Le Coguic
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  9. Loïc Campion
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  10. Françoise Kraeber-Bodéré
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Corresponding author

Correspondence to Caroline Rousseau.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Rousseau, C., Rousseau, T., Mathieu, C. et al. Laparoscopic sentinel lymph node dissection in prostate cancer patients: the additional value depends on preoperative data. Eur J Nucl Med Mol Imaging 43, 1849–1856 (2016). https://doi.org/10.1007/s00259-016-3397-2

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  • DOI: https://doi.org/10.1007/s00259-016-3397-2

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