The Diagnostic Value of the Sentinel Node Procedure to Detect Occult Lymph Node Metastases in PSMA PET/CT Node–Negative Prostate Cancer Patients
Jan J. Duin, Hilda A. de Barros, Maarten L. Donswijk, Eva E. Schaake, Tim M. van der Sluis, Esther Wit, Fijs W. B. van Leeuwen, Pim J. van Leeuwen, Henk G. van der Poel
Abstract
Our objective was to assess the diagnostic value of the sentinel node (SN) procedure for lymph node staging in primary intermediate- and high-risk prostate cancer patients with node-negative results on prostate-specific membrane antigen PET/CT (miN0). <b>Methods:</b> From 2016 to 2022, 154 patients with primary, miN0 PCa were retrospectively included. All patients had a Briganti nomogram–assessed nodal risk of more than 5% and underwent a robot-assisted SN procedure for nodal staging. The prevalence of nodal metastases at histopathology and the occurrence of surgical complications according to the Clavien–Dindo classification were evaluated. <b>Results:</b> The SN procedure yielded 84 (14%) tumor-positive lymph nodes with a median metastasis size of 3 mm (interquartile range, 1–4 mm). In total, 55 patients (36%) were reclassified as pN1. A complication of Clavien–Dindo grade 3 or higher occured in 1 patient (0.6%). <b>Conclusion:</b> The SN procedure classified 36% of patients with miN0 prostate cancer with an elevated risk of nodal metastases as pN1.