EURURO Vol. 71 No. 4

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detection rate of 93.8% and sensitivity of 94%. There are
methodological issues with the review, with an AMSTAR
assessment revealing only five out of 11 items scoring
positively . In addition, there was inadequate explora-
tion of how clinical heterogeneity, in terms of how issues
such as different definitions of SN, disease risk stratification,
or different reference standards reported in studies, may
have affected the findings. Crucially, how the authors
defined and calculated their diagnostic accuracy elements
was not described. This is an important omission because,
as shown in our review, there is considerable heterogeneity
in terms of how these elements are calculated in the
literature. Nevertheless, the results broadly correspond to
our findings.
4. Conclusions
There is heterogeneity in definitions and technical aspects
of performing SNB in PCa and in outcome definition,
measurement, and reporting. The current data suggest that
as a diagnostic tool, SNB in PCa is almost equivalent to
ePLND, with a low NDR of 4.1%, high overall sensitivity of
95.2%, specificity of 100%, and a low FN rate of 4.8%. SNB
provided no additional diagnostic value over ePLND.
However, SNB combined with ePLND provided better nodal
removal by increasing the number of affected nodes in 5% of
cases, indicating therapeutic potential. Consequently, there
is a valid argument for combining SNB with ePLND in high-
risk disease for which the prevalence of lymph node
invasion is high in non-SNs. Future studies are needed to
explore if potential benefits translate into equivalent or
improved oncologic outcomes. To achieve this, there is an
urgent need to standardize and optimize SNB in PCa by
developing consensus statements on its definitions, inter-
ventions, outcome measurements, and reporting.
Author contributions: Esther M.K. Wit had full access to all the data in the
study and takes responsibility for the integrity of the data and the
accuracy of the data analysis.
Study concept and design: van der Poel, Lam, Wit.
Acquisition of data: Wit, Acar, Grivas, Yuan, Lam, van der Poel.
Analysis and interpretation of data: Wit, Acar, Grivas, MacLennan, Lam,
van der Poel.
Drafting of the manuscript: Wit, Acar, Grivas, MacLennan, Lam, van der
Poel.
Critical revision of the manuscript for important intellectual content:
Horenblas, Liedberg, Valdes Olmos, van Leeuwen, van den Berg, Winter,
Wawroschek, Hruby, Janetschek, Vidal-Sicart.
Statistical analysis: Wit, van der Poel.
Obtaining funding: None.
Administrative, technical, or material support: Yuan, MacLennan, Lam.
Supervision: van der Poel, Lam.
Other: None.
Financial disclosures: Esther M.K. Wit certifies that all conflicts of
interest, including specific financial interests and relationships and
affiliations relevant to the subject matter or materials discussed in the
manuscript (eg, employment/affiliation, grants or funding, consultan-
cies, honoraria, stock ownership or options, expert testimony, royalties,
or patents filed, received, or pending), are the following: None.
Funding/Support and role of the sponsor: None.
Acknowledgments: The authors thank Pilar Paredes for her contribution.
Appendix A. Supplementary data
Supplementary data associated with this article can be
found, in the online version, at
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