SpringerLink
Log in

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

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A (2017) Cancer Statistics, 2017. CA Cancer J Clin 67(1):7–30

    Article  Google Scholar 

  2. Talab SS, Preston MA, Elmi A, Tabatabaei S (2012) Prostate cancer imaging: what the urologist wants to know. Radiol Clin N Am 50(6):1015–1041

    Article  Google Scholar 

  3. Crawford ED, Stone NN, Yu EY et al (2014) Challenges and recommendations for early identification of metastatic disease in prostate cancer. Urology 83(3):664–669

    Article  Google Scholar 

  4. Pinto F, Totaro A, Palermo G et al (2012) Imaging in prostate cancer staging: present role and future perspectives. Urol Int 88(2):125–136

    Article  Google Scholar 

  5. Hovels AM, Heesakkers RA, Adang EM et al (2008) The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 63(4):387–395

    Article  CAS  Google Scholar 

  6. Bayne CE, Williams SB, Cooperberg MR et al (2016) Treatment of the primary tumor in metastatic prostate cancer: current concepts and future perspectives. Eur Urol 69(5):775–787

    Article  Google Scholar 

  7. Husband JE (2002) CT/MRI of nodal metastases in pelvic cancer. Cancer Imaging 2(2):123–129

    PubMed Central  Google Scholar 

  8. Budiharto T, Joniau S, Lerut E et al (2011) Prospective evaluation of 11C-choline positron emission tomography/computed tomography and diffusion-weighted magnetic resonance imaging for the nodal staging of prostate cancer with a high risk of lymph node metastases. Eur Urol 60(1):125–130

    Article  Google Scholar 

  9. Kiss B, Thoeny HC, Studer UE (2016) Current Status of Lymph Node Imaging in Bladder and Prostate Cancer. Urology 96:1–7

    Article  Google Scholar 

  10. Calais J, Ceci F, Eiber M et al (2019) (18)F-fluciclovine PET-CT and (68)Ga-PSMA-11 PET-CT in patients with early biochemical recurrence after prostatectomy: a prospective, single-centre, single-arm, comparative imaging trial. Lancet Oncol 20:1286

    Article  CAS  Google Scholar 

  11. Mansbridge M, Chung E, Rhee H (2019) The use of MRI and PET Imaging studies for prostate cancer management: brief update, clinical recommendations, and technological limitations. Med Sci (Basel) 7:8

    Google Scholar 

  12. Briganti A, Blute ML, Eastham JH et al (2009) Pelvic lymph node dissection in prostate cancer. Eur Urol 55(6):1251–1265

    Article  Google Scholar 

  13. Weinreb JC, Barentsz JO, Choyke PL et al (2016) PI-RADS prostate imaging—reporting and data system: 2015, version 2. Eur Urol 69(1):16–40

    Article  Google Scholar 

  14. Moschini M, Briganti A, Murphy CR et al (2016) Outcomes for patients with clinical lymphadenopathy treated with radical prostatectomy. Eur Urol 69(2):193–196

    Article  Google Scholar 

  15. Cher ML, Dhir A, Auffenberg GB et al (2017) Appropriateness criteria for active surveillance of prostate cancer. J Urol 197(1):67–74

    Article  Google Scholar 

  16. Risko R, Merdan S, Womble PR et al (2014) Clinical predictors and recommendations for staging computed tomography scan among men with prostate cancer. Urology 84(6):1329–1334

    Article  Google Scholar 

  17. Lecouvet FE, Oprea-Lager DE, Liu Y et al (2018) Use of modern imaging methods to facilitate trials of metastasis-directed therapy for oligometastatic disease in prostate cancer: a consensus recommendation from the EORTC Imaging Group. Lancet Oncol 19(10):e534–e545

    Article  Google Scholar 

  18. Cook GJR, Kulkarni M, Warbey VS (2019) PSMA PET/CT imaging for primary staging of intermediate and high-risk prostate cancer. BJU Int 124(3):357–358

    Article  Google Scholar 

  19. Giganti F, Rosenkrantz AB, Villeirs G et al (2019) The evolution of MRI of the prostate: the past, the present, and the future. Am J Roentgenol. 2019:1–13

    Google Scholar 

  20. Kalapara AA, Nzenza T, Pan HY et al (2019) Detection and localisation of primary prostate cancer using (68) Ga-PSMA PET/CT compared with mpMRI and radical prostatectomy specimens. BJU Int. https://doi.org/10.1111/bju.14858. [Epub ahead of print]

    Article  Google Scholar 

  21. Heidenreich A, Bastian PJ, Bellmunt J et al (2014) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 65(1):124–137

    Article  Google Scholar 

  22. Hurley P, Dhir A, Gao Y et al (2017) A statewide intervention improves appropriate imaging in localized prostate cancer. J Urol 197(5):1222–1228

    Article  Google Scholar 

  23. Perez-Lopez R, Tunariu N, Padhani AR et al (2019) Imaging diagnosis and follow-up of advanced prostate cancer: clinical perspectives and state of the art. Radiology 292(2):273–286

    Article  Google Scholar 

  24. Kim SJ, Lee SW (2019) Diagnostic accuracy of (F)18 flucholine PET/CT for preoperative lymph node staging in newly diagnosed prostate cancer patients; a systematic review and meta-analysis. Br J Radiol 92(1101):20190193

    Article  Google Scholar 

  25. Maurer T, Gschwend JE, Rauscher I et al (2016) Diagnostic efficacy of (68)gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol 195(5):1436–1443

    Article  Google Scholar 

  26. Koerber SA, Stach G, Kratochwil C et al (2019) Lymph node involvement in treatment-naive prostate cancer patients: correlation of PSMA-PET/CT imaging and Roach formula in 280 men in the Radiotherapeutic management. J Nucl Med 61:46

    Article  Google Scholar 

  27. Afshar-Oromieh A, Vollnberg B, Alberts I et al (2019) Comparison of PSMA-ligand PET/CT and multiparametric MRI for the detection of recurrent prostate cancer in the pelvis. Eur J Nucl Med Mol Imaging 46(11):2289–2297

    Article  Google Scholar 

  28. Meissner S, Janssen JC, Prasad V et al (2019) Accuracy of standard clinical 3T prostate MRI for pelvic lymph node staging: comparison to (68)Ga-PSMA PET-CT. Sci Rep 9(1):10727

    Article  Google Scholar 

  29. Mottet N, van den Bergh RCN, Briers E et al (2018) EAU—ESTRO—ESUR—SIOG Guidelines on Prostate Cancer 2018. European Association of Urology Guidelines 2018 Edition. Arnhem, The Netherlands: European Association of Urology Guidelines Office

  30. Roach M 3rd, Marquez C, Yuo HS et al (1994) Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 28(1):33–37

    Article  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the significant contribution of the clinical champions, urologists, and data abstractors in each participating practice. In addition, we would like to acknowledge the support provided by the Value Partnerships program at Blue Cross Blue Shield of Michigan. We would also like to acknowledge the support provided by the Betz Family Endowment for Cancer Research (RG0813-1036). Funding was provided in part by the Spectrum Health Foundation. We also acknowledge Crystal Farrell and Stephen Babitz for critical review of the manuscript and Sabrina Noyes for administrative support.

Author information

Authors and Affiliations

  1. Spectrum Health, 145 Michigan Street NE, Grand Rapids, MI, USA

    Henry Peabody, Brian R. Lane, Andrew Moriarity & Christopher M. Brede

  2. Michigan State University College of Human Medicine, Grand Rapids, MI, USA

    Brian R. Lane

  3. Michigan Medicine, Ann Arbor, MI, USA

    Ji Qi, Tae Kim, James E. Montie & Jeffrey Montgomery

  4. Advanced Radiology Services, PC, Grand Rapids, MI, USA

    Andrew Moriarity

Authors
  1. Henry Peabody
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian R. Lane
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ji Qi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James E. Montie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrew Moriarity
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christopher M. Brede
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jeffrey Montgomery
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

For the Michigan Urological Surgery Improvement Collaborative

Contributions

HP: data collection, manuscript writing. BR Lane: project development, data management, data analysis, manuscript writing/editing. JQ: data analysis. TK: data management, manuscript editing. JEM: project development, manuscript editing. AM: data management, manuscript editing. CMB: project development, data management, manuscript editing. JM: project development; manuscript editing. Michigan Urological Surgery Improvement Collaborative: project development, data collection and management.

Corresponding author

Correspondence to Brian R. Lane.

Ethics declarations

Conflicts of interest

The authors have no conflicts of interest.

Research involving human participants

Each MUSIC practice obtained an exemption or approval for collaborative participation from a local Institutional Review Board.

Informed consent

Not applicable as this is a quality improvement study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peabody, H., Lane, B.R., Qi, J. et al. Limitations of abdominopelvic CT and multiparametric MR imaging for detection of lymph node metastases prior to radical prostatectomy. World J Urol 39, 779–785 (2021). https://doi.org/10.1007/s00345-020-03227-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-020-03227-7

Keywords

Search

Navigation