title: Sentinel Node Procedure in Prostate Cancer: A Systematic Review to Assess Diagnostic Accuracy.
abstract: 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.
  
  
  
  To assess the diagnostic accuracy of SNB in PCa.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  This literature review showed a high diagnostic accuracy for sentinel node biopsy in detecting positive lymph nodes in prostate cancer, but further studies are needed to explore the effect of sentinel node biopsy on complications and oncologic outcome.
authors.affiliation: Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: e.wit@nki.nl.
authors.forename: Esther M K
authors.initials: EMK
authors.lastname: Wit
authors.affiliation: Department of Urology, Eryaman Hospital, Ankara, Turkey.
authors.forename: Cenk
authors.initials: C
authors.lastname: Acar
authors.affiliation: Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Grivas
authors.affiliation: Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Cathy
authors.initials: C
authors.lastname: Yuan
authors.affiliation: Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Simon
authors.initials: S
authors.lastname: Horenblas
authors.affiliation: Department of Urology, Skåne University Hospital Malmö and Department of Translational Medicine Lund University, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Liedberg
authors.affiliation: Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Renato A
authors.initials: RA
authors.lastname: Valdes Olmos
authors.affiliation: Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Fijs W B
authors.initials: FWB
authors.lastname: van Leeuwen
authors.affiliation: Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Nynke S
authors.initials: NS
authors.lastname: van den Berg
authors.affiliation: University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Winter
authors.affiliation: University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Wawroschek
authors.affiliation: Department of Urology, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Hruby
authors.affiliation: Department of Urology, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Günter
authors.initials: G
authors.lastname: Janetschek
authors.affiliation: Department of Nuclear Medicine, Hospital Clinic Universitari de Barcelona, Barcelona, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Vidal-Sicart
authors.affiliation: Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: MacLennan
authors.affiliation: Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Lam
authors.affiliation: Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Henk G
authors.initials: HG
authors.lastname: van der Poel
mesh_terms: D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000473:pathology*; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
keywords: Diagnostic accuracy; Pelvic lymph node dissection; Prostate cancer; Sentinel node; Systematic review; Targeted lymph node biopsy