Scripties UMCG - Rijksuniversiteit Groningen
 
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The detection of lymph node metastases in primary diagnosed prostate cancer :The combination of prostate-specific membrane antigen positron emission tomography / computed tomography and sentinel node biopsy provides accurate nodal staging

(2018) Hinsenveld, F.J. (Florentien)

Introduction: Since conventional imaging has limited diagnostic value for detecting lymph node metastases (LNM) in primary diagnosed prostate cancer (PCa), an extended pelvic lymph node dissection (ePLND) is the golden standard. Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) has high specificity (95%) and moderate sensitivity (64%) for detecting LNM. Sentinel node biopsy (SNB) has high sensitivity (95%) and high specificity (100%) for detecting LNM. The aim of this study was to assess both diagnostic modalities for detecting LNM in primary PCa patients. Methods: Between January 2017 and August 2018, all patients with primary PCa, who had a preoperative PSMA PET/CT followed by robot-assisted radical prostatectomy and ePLND based on Briganti >7% were retrospectively analyzed. Patients with negative PSMA PET/CT were possible candidates for SNB. An ePLND was used as reference standard. Results: Hundred patients were included, of which 13 had a positive PSMA PET/CT. Twenty-five of 87 patients with negative PSMA PET/CT had SNB. In total, after redefining two cases with incomplete ePLND, 27 patients had LNM (pN1), of which 12 patients (44.4%) were correctly detected with PSMA PET/CT. Seventy-two of 73 patients without LNM (pN0) had a negative PSMA PET/CT (98.6%). SNB correctly staged all 25 patients, including four pN1, resulting in sensitivity and specificity of 100%. The combination of both modalities identified all pN1 patients and performed correct LN-staging in 37 of 38 patients (97.4%). Conclusion: PSMA PET/CT has high specificity and moderate sensitivity for detecting LNM. Adding SNB in patients with a negative PSMA PET/CT increases sensitivity to 100%. Combining both modalities led to a high accuracy for LN-staging of 97.4% in primary diagnosed PCa.






 
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