EURURO Vol. 71 No. 4

Review – Prostate Cancer

Sentinel Node Procedure in Prostate Cancer:

A Systematic Review to Assess Diagnostic Accuracy

Esther M.K. Wit

a , * ,

Cenk Acar

b ,

Nikolaos Grivas

a ,

Cathy Yuan

c ,

Simon Horenblas

a ,

Fredrik Liedberg

d ,

Renato A. Valdes Olmos

e ,

Fijs W.B. van Leeuwen

e ,

Nynke S. van den Berg

e ,

Alexander Winter

f ,

Friedhelm Wawroschek

f ,

Stephan Hruby

g ,

Gu¨nter Janetschek

g ,

Sergi Vidal-Sicart

h ,

Steven MacLennan

c ,

Thomas B. Lam

c , i ,

Henk G. van der Poel

Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands;

Department of Urology, Eryaman Hospital, Ankara, Turkey;

Academic Urology Unit, University of Aberdeen, Aberdeen, UK;

Department of Urology, Ska˚ne University Hospital Malmo¨ and Department of Translational

Medicine Lund University, Sweden;

Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden,

The Netherlands;

University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg,

Germany;

Department of Urology, Paracelsus Medical University, Salzburg, Austria;

Department of Nuclear Medicine, Hospital Clinic Universitari de

Barcelona, Barcelona, Spain;

Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK

E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 5 9 6 – 6 0 5

available at

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journal homepage:

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Article info

Article history:

Accepted September 2, 2016

Associate Editor:

Giacomo Novara

Keywords:

Prostate cancer

Sentinel node

Targeted lymph node biopsy

Pelvic lymph node dissection

Diagnostic accuracy

Systematic review

Abstract

Context:

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.

Objective:

To assess the diagnostic accuracy of SNB in PCa.

Evidence acquisition:

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.

Evidence synthesis:

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.

Conclusions:

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.

Patient summary:

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.

* Corresponding author. Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121,

Amsterdam 1066CX, The Netherlands. Tel. +31 20 5122553; Fax: +31-205122459.

E-mail address:

e.wit@nki.nl

(E.M.K. Wit).

http://dx.doi.org/10.1016/j.eururo.2016.09.007

0302-2838/