Comparison of Nodal Risk Formula and MR Lymphography for Predicting Lymph Node Involvement in Prostate Cancer

• Published in: International journal of radiation oncology, biology, physics Vol. 81; no. 1; pp. 8 - 15
• Main Authors: Deserno, Willem M.L.L.G., M.D., M.Sc, Debats, Oscar A., M.D., M.Sc, Rozema, Tom, M.D, Fortuin, Ansje S., M.D, Heesakkers, Roel A.M., M.D, Hoogeveen, Yvonne, Ph.D, Peer, Petronella G.M., Ph.D, Barentsz, Jelle O., M.D., Ph.D, van Lin, Emile N.J.T., M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2011; Elsevier
• Subjects: Biological and medical sciences; BODY; Cardiovascular system; CHALCOGENIDES; Dextrans; DISEASES; Electron Spin Resonance Spectroscopy; GLANDS; Gynecology. Andrology. Obstetrics; HAZARDS; Hematology, Oncology and Palliative Medicine; HISTOLOGY; Humans; Investigative techniques, diagnostic techniques (general aspects); IRON COMPOUNDS; IRON OXIDES; LYMPH NODES; Lymphatic Metastasis - diagnosis; LYMPHATIC SYSTEM; Lymphography - methods; MAGNETIC RESONANCE; Magnetic Resonance Imaging - methods; MAGNETISM; Magnetite Nanoparticles; Male; Male genital diseases; MALE GENITALS; MATHEMATICS; Medical sciences; MEDICINE; METASTASES; MR lymphography; NEOPLASMS; Nephrology. Urinary tract diseases; Nodal risk formula; NUCLEAR MEDICINE; ORGANS; OXIDES; OXYGEN COMPOUNDS; PARAMAGNETISM; Predictive Value of Tests; PROSTATE; Prostate cancer; Prostatic Neoplasms - pathology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; REGRESSION ANALYSIS; RESONANCE; Risk Assessment; ROC Curve; SENSITIVITY; Sensitivity and Specificity; SPECIFICITY; STATISTICS; THERAPY; TRANSITION ELEMENT COMPOUNDS; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; USPIO; MR lymphography; Regression analysis; USPIO; Prostate cancer; Nodal risk formula; Urinary system disease; Prostate disease; Radiodiagnosis; Malignant tumor; Lymphography; Adenopathy; Risk factor; Male genital diseases; Comparative study; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2010.05.043

Purpose To compare the nodal risk formula (NRF) as a predictor for lymph node (LN) metastasis in patients with prostate cancer with magnetic resonance lymphography (MRL) using Ultrasmall Super-Paramagnetic particles of Iron Oxide (USPIO) and with histology as gold standard. Methods and Materials Logistic regression analysis was performed with the results of histopathological evaluation of the LN as dependent variable and the nodal risk according to the NRF and the result of MRL as independent input variables. Receiver operating characteristic (ROC) analysis was performed to assess the performance of the models. Results The analysis included 375 patients. In the single-predictor regression models, the NRF and MRL results were both significantly ( p <0.001) predictive of the presence of LN metastasis. In the models with both predictors included, NRF was nonsignificant ( p = 0.126), but MRL remained significant ( p <0.001). For NRF, sensitivity was 0.79 and specificity was 0.38; for MRL, sensitivity was 0.82 and specificity was 0.93. After a negative MRL result, the probability of LN metastasis is 4% regardless of the NRF result. After a positive MRL, the probability of having LN metastasis is 68%. Conclusions MRL is a better predictor of the presence of LN metastasis than NRF. Using only the NRF can lead to a significant overtreatment on the pelvic LN by radiation therapy. When the MRL result is available, the NRF is no longer of added value.