title: Laparoscopic sentinel lymph node dissection in prostate cancer patients: the additional value depends on preoperative data.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Nuclear Medicine Unit, ICO Gauducheau Cancer Center, Saint Herblain, France. caroline.rousseau@ico.unicancer.fr.|Nantes-Angers Cancer Research Center, INSERM U892, CNRS UMR 6299, University of Nantes, Nantes, France. caroline.rousseau@ico.unicancer.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Rousseau
authors.affiliation: Urologic Clinic Nantes-Atlantis, Saint-Herblain, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Rousseau
authors.affiliation: Nuclear Medicine Unit, ICO Gauducheau Cancer Center, Saint Herblain, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Mathieu
authors.affiliation: Urologic Clinic Nantes-Atlantis, Saint-Herblain, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Lacoste
authors.affiliation: Urologic Clinic Nantes-Atlantis, Saint-Herblain, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Potiron
authors.affiliation: Anatomopathology Unit, Institut d'Histopathologie, Nantes, France.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Aillet
authors.affiliation: Urologic Clinic Nantes-Atlantis, Saint-Herblain, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Nevoux
authors.affiliation: Urologic Clinic Nantes-Atlantis, Saint-Herblain, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Le Coguic
authors.affiliation: Nantes-Angers Cancer Research Center, INSERM U892, CNRS UMR 6299, University of Nantes, Nantes, France.|Statistics Unit, ICO Gauducheau Cancer Center, Saint Herblain, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Campion
authors.affiliation: Nuclear Medicine Unit, ICO Gauducheau Cancer Center, Saint Herblain, France.|Nantes-Angers Cancer Research Center, INSERM U892, CNRS UMR 6299, University of Nantes, Nantes, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Kraeber-Bodéré
mesh_terms: D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
keywords: Laparoscopic surgery; Nomogram; Prostate cancer; Sentinel lymph node