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JU INSIGHT: Radioisotope-guided Lymphadenectomy for Pelvic Lymph Node Staging in Patients With Intermediate- and High-risk Prostate Cancer (The Prospective SENTINELLE Study)
By: François Lannes, MD; Michael Baboudjian, MD; Alain Ruffion, MD, PhD; Mathieu Rouy, MD; Francesco Giammarile, MD; Thierry Rousseau, MD; Françoise Kraeber-Bodéré, MD, PhD; Caroline Rousseau, MD; Daniela Rusu, MD; Mathilde Colombié, MD; Isabelle Brenot-Rossi, MD; Dominique Rossi, MD, PhD; Nicolas Mottet, MD, PhD; Cyrille Bastide, MD, PhD | Posted on: 16 Feb 2023
Lannes F, Baboudjian M, Ruffion A, et al. Radioisotope-guided lymphadenectomy for pelvic lymph node staging in patients with intermediate- and high-risk prostate cancer (the prospective SENTINELLE study). J Urol. 2023;209(2)364-373.
Study Need and Importance
Two recent randomized controlled trials failed to show any oncological benefits of extended pelvic lymph node dissection (ePLND) over limited pelvic lymph node dissection in patients undergoing radical prostatectomy for prostate cancer (PCa). The perioperative morbidity of pelvic lymph node dissection significantly correlates with the extent of the dissection. The sentinel lymph node biopsy (SLNB) method has been validated to facilitate the detection of occult metastasis in clinically node-negative areas. Early retrospective reports suggest that as a diagnostic tool, SLNB in PCa is almost equivalent to ePLND, with the possibility to detect metastatic nodes located outside the standard ePLND template with less morbidity.
What We Found
Sensitivity of SLNB method to detect lymph node metastases was 0.954, which is much higher than other preoperative staging methods reported such as CT scan, magnetic resonance imaging, prostate-specific membrane antigen positron emission tomography/CT or the 2019 Gandaglia nomogram. More than 99% of patients were correctly staged compared to the standard ePLND, with only 1 false-negative case recorded (see Table). The SLNB method was well tolerated and no complications were reported due to tracer injection or intraoperative use of the gamma probe.
Table. Case Description of 22/162 Men With Lymph Node Metastases
| No. | No. of +SLNs | Ratio +SLNs/all +LNs |
|---|---|---|
| 1 | 1 | 1/1 |
| 2 | 1 | 1/1 |
| 3 | 1 | 1/1 |
| 4 | 1 | 1/1 |
| 5 | 1 | 1/1 |
| 6 | 1 | 1/1 |
| 7 | 2 | 2/2 |
| 8 | 1 | 1/1 |
| 9 | 3 | 3/3 |
| 10 | 1 | 1/1 |
| 11 | 2 | 2/7 |
| 12 | 1 | 1/1 |
| 13 | 1 | 1/1 |
| 14 | 3 | 3/3 |
| 15 | 1 | 1/1 |
| 16 | 1 | 1/5 |
| 17 | 1 | 1/1 |
| 18 | 4 | 4/6 |
| 19 | 0 | 0/1 |
| 20 | 1 | 1/3 |
| 21 | 1 | 1/1 |
| 22 | 2 | 2/2 |
| Abbreviations: LN, lymph node; SLN, sentinel lymph node. | ||
Limitations
Our clinical trial was not designed to evaluate the long-term oncological outcomes of the SLNB method. Second, there were few pN+ patients in our cohort. Finally, due to the unavailability of a dedicated gamma probe for minimally invasive surgery and the gradual adoption of robotic surgery during the study, we faced difficulties regarding patient inclusion.
Interpretation for Patient Care
SLNB is an effective method for lymph node staging and has the potential to avoid a significant number of ePLNDs in patients with intermediate- or high-risk localized PCa.
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