Sentinel node mapping in the prostate cancer

Summary

Aim: Sentinel node (SN) biopsy is becoming a standard procedure in the management of several malignancies. Several groups have evaluated the feasibility and value of this procedure in prostate cancer patients. In the current meta-analysis, we comprehensively and quantitatively summarized the results of these studies. Methods: Several databases including Medline, SCOPUS, Google Scholar, Ovid, Springer, and Science direct were systematically searched for the relevant studies regarding SL biopsy in the prostate cancer (“prostate” AND “sentinel” as search keywords). The outcomes of interest were sensitivity and detection rate of the procedure. Results: For detection rate and sensitivity 21 and 16 studies met the criteria of inclusion respectively. Pooled detection rate was 93.8% (95% CI 89–96.6%). Cochrane Q value was 216.077 (I² = 89.81% and p < 0.001). Pooled sensitivity was 94% (95% CI 91–96%). Cochrane Q value was 14.12 (I² = 0.0 and p = 0.516). Conclusion: SL biopsy can prevent unnecessary pelvic lymph node dissection in prostate cancer patients. This procedure is feasible with low false negative rate and high detection rate.

Zusammenfassung

Ziel: Die Wächterlymphknoten(SN)-Biopsie ist ein Standardverfahren in der Abklärung maligner Tumore. Verschiedene Gruppen haben Machbarkeit und Nutzen dieses Verfahrens bei Patienten mit Prostatakarzinom untersucht. In der vorliegenden Metaanalyse wurden die Studienergebnisse zusammengefasst. Methoden: Datenbanken, darunter Medline, SCOPUS, Google Scholar, Ovid, Springer und Science direct wurden systematisch nach relevanten Studien zu SN-Biopsien bei Prostatakarzinom durchsucht („Prostata“ UND „Sentinel“ als Suchbegriffe). Sensitivität und Detektionsrate dieses Verfahrens waren die Zielparameter. Ergebnisse: Bzgl. Detektionsrate und Sensitivität erfüllten 21 bzw. 16 Studien die Einschlusskriterien. Die gepoolte Detektionsrate lag bei 93,8% (95%-KI 89–96,6%), der Q-Wert nach Cochrane bei 216,077 (I² = 89,81% und p < 0,001). Die gepoolte Sensitivität betrug 94% (95%-KI 91–96%); der Q-Wert nach Cochrane lag bei 14,12 (I² = 0,0 und p = 0,516). Schlussfolgerung: Mit der Wächterlymphknoten-Biopsie können unnötige pelvine Lymphadenektomien bei Patienten mit Prostatakarzinom vermieden werden. Wegen einer niedrigen Rate an falsch negativen Ergebnissen und einer hohen Detektionsrate ist dieses Verfahren gut einsetzbar.

Keywords

Prostate cancer - sentinel node biopsy - lympho scintigraphy - meta-analysis

Schlüsselwörter

Prostatakarzinom - Wächterlymphknoten-Biopsie - Lymphszintigraphie - Metaanalyse

• References

• 1 www.cebm.net/index.aspx?o=1025.
• 2 Bader P, Burkhard FC, Markwalder R. et al. Is a limited lymph node dissection an adequate staging procedure for prostate cancer?. J Urol 2002; 168: 514-518.
• 3 Beheshti M, Imamovic L, Broinger G. et al. ¹⁸F choline PET/CT in the preoperative staging of prostate cancer in patients with intermediate or high risk of extracapsular disease: a prospective study of 130 patients. Radiology 2010; 254: 925-933.
• 4 Beri A, Janetschek G. Technology insight: radioguided sentinel lymph node dissection in the staging of prostate cancer. Nat Clin Pract Urol 2006; 3: 602-610.
• 5 Brenot-Rossi I, Bastide C. Commentary on: Validation of sentinel lymph node dissection in prostate cancer: experience in more than 2000 patients. Eur J Nucl Med Mol Imaging 2009; 36: 1375-1376.
• 6 Brenot-Rossi I, Rossi D, Esterni B. et al. Radioguided sentinel lymph node dissection in patients with localised prostate carcinoma: influence of the dose of radiolabelled colloid to avoid failure of the procedure. Eur J Nucl Med Mol Imaging 2008; 35: 32-38.
• 7 Clark T, Parekh DJ, Cookson MS. et al. Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer. J Urol 2003; 169: 145-148.
• 8 Corvin S, Schilling D, Eichhorn K. et al. Laparoscopic sentinel lymph node dissection - a novel technique for the staging of prostate cancer. Eur Urol 2006; 49: 280-285.
• 9 Crawshaw JW, Hadway P, Hoffland D. et al. Sentinel lymph node biopsy using dynamic lymphoscintigraphy combined with ultrasound-guided fine needle aspiration in penile carcinoma. Br J Radiol 2009; 82: 41-48.
• 10 Der Simonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188.
• 11 Egger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. Br Med J 1997; 315: 629-634.
• 12 Fukuda M, Egawa M, Imao T. et al. Detection of sentinel node micrometastasis by step section and immunohistochemistry in patients with prostate cancer. J Urol 2007; 177: 1313-1317.
• 13 Groetelaers RP, van Berlo CL, Nijhuis PH. et al. Axillary recurrences after negative sentinel lymph node biopsy under local anaesthesia for breast cancer: a follow-up study after 5 years. Eur J Surg Oncol 2009; 35: 159-163.
• 14 Hacker A, Jeschke S, Leeb K. et al. Detection of pelvic lymph node metastases in patients with clinically localized prostate cancer: comparison of [¹⁸F]fluorocholine positron emission tomography-computerized tomography and laparoscopic radioisotope guided sentinel lymph node dissection. J Urol 2006; 176: 2014-2018.
• 15 Hautmann S, Beitz S, Naumann M. et al. Extended sentinel lymph node dissection in radical prostatectomy for prostate cancer: a study in the Kiel risk population. Urologe A 2008; 47: 299-303.
• 16 Heidenreich A, Aus G, Bolla M. et al. EAU guidelines on prostate cancer. Eur Urol 2008; 53: 68-80.
• 17 Heidenreich A, Varga Z, von Knobloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 2002; 167: 1681-1686.
• 18 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-1558.
• 19 Hinev A, Klissarova A, Ghenev P. et al. Radioisotopic detection of sentinel lymph nodes in clinically localized high-risk prostate cancer. J BUON 2009; 14: 661-667.
• 20 Holl G, Dorn R, Wengenmair H. et al. Validation of sentinel lymph node dissection in prostate cancer: experience in more than 2000 patients. Eur J Nucl Med Mol Imaging 2009; 36: 1377-1382.
• 21 Janetschek G. Can sentinel pelvic lymph node dissection replace extended pelvic lymph node dissection in patients with prostate cancer?. Nat Clin Pract Urol 2007; 4: 636-637.
• 22 Jeschke S, Beri A, Grull M. et al. Laparoscopic radioisotope-guided sentinel lymph node dissection in staging of prostate cancer. Eur Urol 2008; 53: 126-132.
• 23 Kanamaru H, Oyama N, Akino H. et al. Evaluation of prostate cancer using FDG-PET. Hinyokika Kiyo 2000; 46: 851-853.
• 24 Kettlewell S, Moyes C, Bray C. et al. Value of sentinel node status as a prognostic factor in melanoma: prospective observational study. Br Med J 2006; 332: 1423.
• 25 Klitsch MC, Schenner M, Broessner C. et al. Sentinel-lymphadenectomy in radical prostatectomy: Can we rely on this technique?. Eur Urol Suppl 2010; 9: 265.
• 26 Loeb S, Carter HB. Limitations and use of PSA derivatives in the screening and risk stratification of prostate cancer. Urol Oncol 2009; 27: 583-584.
• 27 Mac Neill F, Mansel R, Horgan K. et al. NEW START: the United Kingdom sentinel lymph biopsy training programme. A model of how multi-professional training can achieve competent national performance whilst maintaining patient safety. Breast Cancer Res Treat 2007; 106: S233.
• 28 Malmstrom PU. Lymph node staging in prostatic carcinoma revisited. Acta Oncol 2005; 44: 593-598.
• 29 Marchioro G, Vidali M, Volpe A. et al. Sentinel lymph node surgery in prostate cancer:Results of a prospetctive study with a 10 years follow up. J Urol 2010; 183: e157.
• 30 Maza S, Taupitz M, Taymoorian K. et al. Multimodal fusion imaging ensemble for targeted sentinel lymph node management: initial results of an innovative promising approach for anatomically difficult lymphatic drainage in different tumour entities. Eur J Nucl Med Mol Imaging 2007; 34: 378-383.
• 31 Meinhardt W, Valdes Olmos RA, van der Poel HG. et al. Laparoscopic sentinel node dissection for prostate carcinoma: technical and anatomical observations. Br J Urol Int 2008; 102: 714-717.
• 32 Naito S, Kuroiwa K, Kinukawa N. et al. Validation of Partin tables and development of a preoperative nomogram for Japanese patients with clinically localized prostate cancer using 2005 International Society of Urological Pathology consensus on Gleason grading: data from the Clinicopathological Research Group for Localized Prostate Cancer. J Urol 2008; 180: 904-909.
• 33 Orwin RG. A Fail-SafeN for Effect size in meta-analysis. J Edu Behav Stat 1983; 8: 157-159.
• 34 Parker CC, Husband J, Dearnaley DP. Lymph node staging in clinically localized prostate cancer. Prostate Cancer Prostatic Dis 1999; 2: 191-199.
• 35 Partin AW, Kattan MW, Subong EN. et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA 1997; 277: 1445-1451.
• 36 Picchio M, Crivellaro C, Giovacchini G. et al. PET-CT for treatment planning in prostate cancer. Q J Nucl Med Mol Imaging 2009; 53: 245-268.
• 37 Rousseau T, Lacoste J, Curtet C. et al. Laparoscopic sentinel lymph node (SLN) dissection for clinically localized prostate carcinoma: Preliminary results. Eur Urol Suppl 2010; 9: 317.
• 38 Rusakov I, Alekseev B, Nyushko K. et al. Detection of sentinel lymph nodes in prostate cancer patients. Eur Urol Suppl 2006; 5: 209.
• 39 Salminen E, Hogg A, Binns D. et al. Investigations with FDG-PET scanning in prostate cancer show limited value for clinical practice. Acta Oncol 2002; 41: 425-429.
• 40 Santoro P, Lafranceschina F, Altieri ML. et al. Lymphoscintigraphy as alternative lymph node staging method in early prostatic carcinoma. Eur J Nucl Med Mol Imaging 2008; 35: S157.
• 41 Schafhauser W, Becher H, Schaffhauser R. et al. Is the incidence of lymph node metastases increased with sentinel lymph node dissection in prostate cancer. J Urol Urogynäkol 2006; 13: 11-14.
• 42 Schilling D, Boekeler U, Gakis G. et al. Modified concept for radioisotope-guided sentinel lymph node dissection in prostate cancer. World J Urol. 2010 in press.
• 43 Silva Jr N, Anselmi CE, Anselmi OE. et al. Use of the gamma probe in sentinel lymph node biopsy in patients with prostate cancer. Nucl Med Commun 2005; 26: 1081-1086.
• 44 Stearns ME, Wang M, Hu Y. et al. Expression of a flt-4 (VEGFR3) splicing variant in primary human prostate tumors. VEGF D and flt-4t(Delta773–1081) overexpression is diagnostic for sentinel lymph node metastasis. Lab Invest 2004; 84: 785-795.
• 45 Varga Z, Páczelt A, Balogh I. et al. Nyirokcsomósebészet prosztata- és hólyagrákos betegekben. Füvészkerti Urológus Napok. 2010
• 46 Vermeeren L, Muller SH, Meinhardt W. et al. Optimizing the colloid particle concentration for improved preoperative and intraoperative image-guided detection of sentinel nodes in prostate cancer. Eur J Nucl Med Mol Imaging 2010; 37: 1328-1334.
• 47 Vermeeren L, Valdes Olmos RA, Meinhardt W. et al. Intraoperative radioguidance with a portable gamma camera: a novel technique for laparoscopic sentinel node localisation in urological malignancies. Eur J Nucl Med Mol Imaging 2009; 36: 1029-1036.
• 48 Vermeeren L, Valdes Olmos RA, Meinhardt W. et al. Value of SPECT/CT for detection and anatomic localization of sentinel lymph nodes before laparoscopic sentinel node lymphadenectomy in prostate carcinoma. J Nucl Med 2009; 50: 865-870.
• 49 Vogt H, Schmidt M, Bares R. et al. Procedure guideline for sentinel lymph node diagnosis. Nuklearmedizin 2010; 49: 167-172.
• 50 Vogt H, Wawroschek F, Wengenmair H. et al. Sentinel lymph node diagnosis in prostatic carcinoma: I: Method and clinical evaluation. Nuklearmedizin 2002; 41: 95-101.
• 51 Warncke SH, Mattei A, Fuechsel FG. et al. Detection rate and operating time required for gamma probe-guided sentinel lymph node resection after injection of technetium-99m nanocolloid into the prostate with and without preoperative imaging. Eur Urol 2007; 52: 126-132.
• 52 Wawroschek F, Hamm M, Weckermann D. et al. Lymph node staging in clinically localized prostate cancer. Urol Int 2003; 71: 129-135.
• 53 Wawroschek F, Vogt H, Weckermann D. et al. Radioisotope guided pelvic lymph node dissection for prostate cancer. J Urol 2001; 166: 1715-1719.
• 54 Wawroschek F, Vogt H, Weckermann D. et al. The sentinel lymph node concept in prostate cancer - first results of gamma probe-guided sentinel lymph node identification. Eur Urol 1999; 36: 595-600.
• 55 Weckermann D, Dorn R, Trefz M. et al. Sentinel lymph node dissection for prostate cancer: experience with more than 1000 patients. J Urol 2007; 177: 916-920.
• 56 Weckermann D, Goppelt M, Dorn R. et al. Incidence of positive pelvic lymph nodes in patients with prostate cancer, a prostate-specific antigen (PSA) level of < or =10 ng/mL and biopsy Gleason score of < or =6, and their influence on PSA progression-free survival after radical prostatectomy. Br J Urol Int 2006; 97: 1173-1178.
• 57 Weckermann D, Holl G, Wagner T. et al. Sentinel node dissection in prostate cancer: current status. Urologe A 2007; 46: 1500-1507.
• 58 Wengenmair H, Kopp J, Vogt H. et al. Sentinel lymph node diagnosis in prostatic carcinoma: II. Biokinetics and dosimetry of 99mTc-nanocolloid after intraprostatic injection. Nuklearmedizin 2002; 41: 102-107.
• 59 Woods ME, Ouwenga M, Quek ML. The role of pelvic lymphadenectomy in the management of prostate and bladder cancer. ScientificWorldJournal 2007; 7: 789-799.
• 60 Zamora J, Abraira V, Muriel A. et al. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 2006; 6: 31.