Sentinel node procedure in prostate cancer

a systematic review to assess diagnostic accuracy

Esther M. K. Wit, Cenk Acar, Nikolaos Grivas, Cathy Yuan , Simon Horenblas, Fredrik Liedberg, Renato A. Valdes Olmos , Fijs W. B. van Leeuwen, Nynke S. van den Berg , Alexander Winter, Friedhelm Wawroschek , Stephan Hruby , Günter Janetschek , Sergi Vidal-Sicart , Steven MacLennan, Thomas B. Lam, Henk G. van der Poel

Research output: Contribution to journalArticle

31 Citations (Scopus)
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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.
Original languageEnglish
Pages (from-to)596–605
Number of pages10
JournalEuropean Urology
Volume71
Issue number4
Early online date14 Sep 2016
DOIs
Publication statusPublished - 1 Apr 2017

Fingerprint

Prostatic Neoplasms
Biopsy
Lymph Nodes
Sensitivity and Specificity
Lymph Node Excision
Libraries
cyhalothrin
Guidelines
Neoplasm Metastasis

Keywords

  • prostate cancer
  • sentinel node
  • targeted lymph node biopsy
  • pelvic lymph node dissection
  • diagnostic accuracy
  • systematic review

Cite this

Wit, E. M. K., Acar, C., Grivas, N., Yuan , C., Horenblas, S., Liedberg, F., ... van der Poel, H. G. (2017). Sentinel node procedure in prostate cancer: a systematic review to assess diagnostic accuracy. European Urology, 71(4), 596–605. https://doi.org/10.1016/j.eururo.2016.09.007

Sentinel node procedure in prostate cancer : a systematic review to assess diagnostic accuracy. / Wit, Esther M. K. ; Acar, Cenk; Grivas, Nikolaos ; Yuan , Cathy ; Horenblas, Simon; Liedberg, Fredrik; Olmos , Renato A. Valdes ; van Leeuwen, Fijs W. B. ; van den Berg , Nynke S.; Winter, Alexander; Wawroschek , Friedhelm ; Hruby , Stephan ; Janetschek , Günter ; Vidal-Sicart , Sergi ; MacLennan, Steven; Lam, Thomas B.; van der Poel, Henk G.

In: European Urology, Vol. 71, No. 4, 01.04.2017, p. 596–605.

Research output: Contribution to journalArticle

Wit, EMK, Acar, C, Grivas, N, Yuan , C, Horenblas, S, Liedberg, F, Olmos , RAV, van Leeuwen, FWB, van den Berg , NS, Winter, A, Wawroschek , F, Hruby , S, Janetschek , G, Vidal-Sicart , S, MacLennan, S, Lam, TB & van der Poel, HG 2017, 'Sentinel node procedure in prostate cancer: a systematic review to assess diagnostic accuracy', European Urology, vol. 71, no. 4, pp. 596–605. https://doi.org/10.1016/j.eururo.2016.09.007
Wit, Esther M. K. ; Acar, Cenk ; Grivas, Nikolaos ; Yuan , Cathy ; Horenblas, Simon ; Liedberg, Fredrik ; Olmos , Renato A. Valdes ; van Leeuwen, Fijs W. B. ; van den Berg , Nynke S. ; Winter, Alexander ; Wawroschek , Friedhelm ; Hruby , Stephan ; Janetschek , Günter ; Vidal-Sicart , Sergi ; MacLennan, Steven ; Lam, Thomas B. ; van der Poel, Henk G. / Sentinel node procedure in prostate cancer : a systematic review to assess diagnostic accuracy. In: European Urology. 2017 ; Vol. 71, No. 4. pp. 596–605.
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title = "Sentinel node procedure in prostate cancer: a systematic review to assess diagnostic accuracy",
abstract = "ContextExtended 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.ObjectiveTo assess the diagnostic accuracy of SNB in PCa.Evidence acquisitionA 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 synthesisOf 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.ConclusionsSNB 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.",
keywords = "prostate cancer, sentinel node, targeted lymph node biopsy, pelvic lymph node dissection, diagnostic accuracy, systematic review",
author = "Wit, {Esther M. K.} and Cenk Acar and Nikolaos Grivas and Cathy Yuan and Simon Horenblas and Fredrik Liedberg and Olmos, {Renato A. Valdes} and {van Leeuwen}, {Fijs W. B.} and {van den Berg}, {Nynke S.} and Alexander Winter and Friedhelm Wawroschek and Stephan Hruby and G{\"u}nter Janetschek and Sergi Vidal-Sicart and Steven MacLennan and Lam, {Thomas B.} and {van der Poel}, {Henk G.}",
note = "Financial disclosures: Esther M.K. Wit certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Funding/Support and role of the sponsor: None. Acknowledgments: The authors thank Pilar Paredes for her contribution.",
year = "2017",
month = "4",
day = "1",
doi = "10.1016/j.eururo.2016.09.007",
language = "English",
volume = "71",
pages = "596–605",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "4",

}

TY - JOUR

T1 - Sentinel node procedure in prostate cancer

T2 - a systematic review to assess diagnostic accuracy

AU - Wit, Esther M. K.

AU - Acar, Cenk

AU - Grivas, Nikolaos

AU - Yuan , Cathy

AU - Horenblas, Simon

AU - Liedberg, Fredrik

AU - Olmos , Renato A. Valdes

AU - van Leeuwen, Fijs W. B.

AU - van den Berg , Nynke S.

AU - Winter, Alexander

AU - Wawroschek , Friedhelm

AU - Hruby , Stephan

AU - Janetschek , Günter

AU - Vidal-Sicart , Sergi

AU - MacLennan, Steven

AU - Lam, Thomas B.

AU - van der Poel, Henk G.

N1 - Financial disclosures: Esther M.K. Wit certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Funding/Support and role of the sponsor: None. Acknowledgments: The authors thank Pilar Paredes for her contribution.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - ContextExtended 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.ObjectiveTo assess the diagnostic accuracy of SNB in PCa.Evidence acquisitionA 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 synthesisOf 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.ConclusionsSNB 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.

AB - ContextExtended 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.ObjectiveTo assess the diagnostic accuracy of SNB in PCa.Evidence acquisitionA 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 synthesisOf 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.ConclusionsSNB 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.

KW - prostate cancer

KW - sentinel node

KW - targeted lymph node biopsy

KW - pelvic lymph node dissection

KW - diagnostic accuracy

KW - systematic review

U2 - 10.1016/j.eururo.2016.09.007

DO - 10.1016/j.eururo.2016.09.007

M3 - Article

VL - 71

SP - 596

EP - 605

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 4

ER -