Reliability of sentinel node procedure for lymph node staging in prostate cancer patients at high risk for lymph node involvement

• Published in: Acta oncologica Vol. 54; no. 6; p. 896
• Main Authors: Van den Bergh, Laura, Joniau, Steven, Haustermans, Karin, Deroose, Christophe M, Isebaert, Sofie, Oyen, Raymond, Mottaghy, Felix M, Ameye, Filip, Berkers, Joost, Van Poppel, Hendrik, Lerut, Evelyne
• Format: Journal Article
• Language: English
• Published: England 01-06-2015
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Aged; Humans; Lymph Node Excision; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Pelvis; Prospective Studies; Prostatectomy; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Reproducibility of Results; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Technetium Tc 99m Aggregated Albumin; Tomography, Emission-Computed, Single-Photon
• ISSN: 1651-226X
• DOI: 10.3109/0284186X.2014.987354

To investigate the reliability of a sentinel node (SN) procedure for nodal staging in prostate cancer (PCa) patients at high risk for lymph node (LN) involvement.
Seventy-four patients with localized prostate adenocarcinoma, who were clinically node-negative and had a risk of LN involvement of ≥ 10% (Partin tables), were prospectively enrolled. Upon intraprostatic 99mTc-nanocolloid injection, they underwent planar scintigraphy and SPECT imaging. Surgical removal of the SN, located by means of a gamma probe, was completed with a superextended LN dissection (seLND) as a reference and followed by radical prostatectomy.
In total, 470 SN (median 6, IQR 3-9) were scintigraphically detected of which 371 (median 4, IQR 2-6) were located by gamma probe and selectively removed during surgery (79%). Histopathology confirmed LN metastases in 37 patients (50%) having 106 affected LN in total (median number per patient 2, IQR 1-4). Twenty-eight patients were node positive (N+) based on the analysis of the resected SN. However, the seLND that was performed as a reference revealed nine additional N+ patients resulting in a sensitivity of 76% (28/37). In total, 15 of 37 patients (41%) had metastases in SN only and could have been spared seLND to remove all affected nodes.
We found a relatively low sensitivity when addressing the SN procedure for nodal staging in PCa patients at high risk for LN involvement. Importantly, only less than half of the N+ patients could have been spared a seLND to remove all affected lymphoid tissue.