Limitations of abdominopelvic CT and multiparametric MR imaging for detection of lymph node metastases prior to radical prostatectomy.

Autor: Peabody H; Spectrum Health, 145 Michigan Street NE, Grand Rapids, MI, USA., Lane BR; Spectrum Health, 145 Michigan Street NE, Grand Rapids, MI, USA. brian.lane@spectrumhealth.org.; Michigan State University College of Human Medicine, Grand Rapids, MI, USA. brian.lane@spectrumhealth.org., Qi J; Michigan Medicine, Ann Arbor, MI, USA., Kim T; Michigan Medicine, Ann Arbor, MI, USA., Montie JE; Michigan Medicine, Ann Arbor, MI, USA., Moriarity A; Spectrum Health, 145 Michigan Street NE, Grand Rapids, MI, USA.; Advanced Radiology Services, PC, Grand Rapids, MI, USA., Brede CM; Spectrum Health, 145 Michigan Street NE, Grand Rapids, MI, USA., Montgomery J; Michigan Medicine, Ann Arbor, MI, USA.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2021 Mar; Vol. 39 (3), pp. 779-785. Date of Electronic Publication: 2020 May 02.
DOI: 10.1007/s00345-020-03227-7
Abstrakt: Purpose: To investigate the performance of pre-surgery CT and multiparametric MRI (mpMRI) to identify lymph node (LN) metastases in the Michigan Urological Surgery Improvement Collaborative (MUSIC). Abdominopelvic CT and mpMRI are commonly used for intermediate- and high-risk prostate cancer (PCa) staging.
Methods: Retrospective analysis of the MUSIC registry identified patients undergoing robot-assisted radical prostatectomy (RP) between 3/2012 and 7/2018. Patients were classified according to pre-surgery imaging modality. Primary outcomes were operating characteristics of CT and mpMRI for detection of pathologic LN involvement (pN1).
Results: A total of 10,250 patients underwent RP and 3924 patients (38.3%) underwent CT and/or mpMRI prior to surgery. Suspicion for LN involvement was identified on 2.3% CT and 1.9% mpMRI. Overall, 391 patients were pN1(3.8%), including 0.1% low-, 2.1% intermediate-, and 10.9% high-risk PCa patients. Of 235 pN1 patients that underwent CT prior, far more had negative (91.1%) than positive (8.9%) findings, yielding sensitivity: 8.9%, specificity: 98.3%, negative predictive value (NPV): 92.1%, and positive predictive value (PPV): 32.3% for CT with regard to LN metastases. Similarly, more patients with pN1 disease had negative mpMRI (81.0%) then suspicious or indeterminate MRI (19.0%), yielding sensitivity: 19.0%, specificity: 97.3%, NPV: 95.9%, and PPV: 26.7%.
Conclusions: Abdominopelvic CT and mpMRI have clear limitations in identifying LN metastases. Additional clinicopathologic features should be considered when making management decisions, as 2.1% and 10.9% with intermediate-and high-risk cancer had metastatic LNs. The majority of pN1 patients had a negative CT or a negative/indeterminate mpMRI prior to RP. Pelvic LN dissection should be performed in RP patients with intermediate- or high-risk PCa, independent of preoperative imaging results.
Databáze: MEDLINE
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