title: Reliability of sentinel node procedure for lymph node staging in prostate cancer patients at high risk for lymph node involvement.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Radiation Oncology, University Hospitals Leuven & Department of Oncology , KU Leuven, Leuven , Belgium.
authors.forename: Laura
authors.initials: L
authors.lastname: Van den Bergh
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
authors.forename: Karin
authors.initials: K
authors.lastname: Haustermans
authors.forename: Christophe M
authors.initials: CM
authors.lastname: Deroose
authors.forename: Sofie
authors.initials: S
authors.lastname: Isebaert
authors.forename: Raymond
authors.initials: R
authors.lastname: Oyen
authors.forename: Felix M
authors.initials: FM
authors.lastname: Mottaghy
authors.forename: Filip
authors.initials: F
authors.lastname: Ameye
authors.forename: Joost
authors.initials: J
authors.lastname: Berkers
authors.forename: Hendrik
authors.initials: H
authors.lastname: Van Poppel
authors.forename: Evelyne
authors.initials: E
authors.lastname: Lerut
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000601:surgery; D000368:Aged; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid