The study included 1,541 consecutive patients with clinically localized CaP treated with radical prostatectomy and ePLND between 2002 and 2009. All patients underwent pre-operative CT scan for staging purposes. A suspicious CT scan was defined as the presence of at least 1 enlarged pelvic node (≥1 cm). Results were compared to the histological presence of lymph node involvement at ePLND. The sensitivity, specificity and accuracy of CT scan in detecting lymph node involvement were calculated according to risk groups: low (PSA<0 ng/ml and biopsy Gleason scum≤6 and cT1), high (PSA>20 ng/ml or biopsy Gleason sum ≥8 or cT3) and intermediate (all the remaining patients). The performance characteristics of CT scan in detecting lymph node involvement was assessed according to most-informative risk cut-offs for lymph node involvement calculated using a nomogram developed on ePLND series.
A CT scan suspicious for lymph node involvement was found in 73 patients (4.7%). Of these, 24 (32.9%) had lymph node involvement at ePLND. Pre-operative risk groups included 471 (30.6%), 689 (44.7%) and 381 (24.7%) patients in the low-, intermediate- and high-risk groups, respectively. Overall sensitivity, specificity and accuracy were 13%, 96% and 54%, respectively. In the low-risk group, sensitivity, specificity and accuracy was 8.3%, 96% and 52%, respectively. In the intermediate-risk group, sensitivity, specificity and accuracy was 4%, 97% and 51%, respectively. In the high-risk group, sensitivity, specificity and accuracy was 18%, 94% and 56%, respectively. After applying the most-informative cut-offs derived from the nomogram (36% and 50% risk of lymph node involvement), the discriminative power of CT scanning for lymph node involvement detection was not too impressive (sensitivity, specificity and accuracy was 23.5%, 93% and 58.3% vs. 28.9%, 87.5% and 56.4% for patients with a calculated lymph node involvement risk >36% and >50%, respectively).
They concluded that the sensitivity and accuracy of CT scan in detecting positive lymph nodes at RP and ePLND are low, even among patients at very high risk of nodal involvement.
Presented by Alberto Briganti, MD, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria
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