The Accuracy of computed tomography for detection lymph node metastasis in prostate cancer in Rajavithi hospital
Purpose;Nowaday,Most prostate cancer patients who wait for Radical prostatectomy have underwent CT imaging preoperatively. We evaluated the accuracy to CT in detecting lymph node metastasis of radical prostatectomy (RP) patients retrospectively.
Methods; The total 281 prostate cancer patients were performed Radical prostatectomy at Rajavithi hospital since Jan 2012 to Dec 2016 and met criteria were 150 patients.Retrospective data was done to evaluate accuracy of CT for detection LN metastasis in prostate cancer and subgroup analysis base on D’Amico risk classification. Statistic analysis of data was performed using percentage,mean,mode for descriptive data and Student T-test,Mann-Whitney U test,Chi-square test and Fisher Exact test for comparisons data.Nomogram performance was assessed by AUC for validation Rajavithi patients about lymph node involvement (LVI)
Results;One hundred and eleven patients underwent laparoscopic radical protatectomy (74%) and underwent retropubic radical prostatectomy (RRP) (26%) .CT scan showed sensitivity and specificity in predicting LNI of 54.55% (6 in 11) and 94.2 %(131 in 139) ,and subgroup analysis found that low risk group(25 patients), CT scan can detect LNI only one patient but pathologic finding was negative (PPV 0% and NPV 100%), intermediate risk group (72 patients) had PPV 25% and NPV 100%(P= 0.002) and high risk group(53 patients) had PPV 55.56% and NPV 88.64%(P=0.003) .Statistic significant only in intermediate and high risk groups. ROC curve analysis predict LNI with CT AUC 69 % and Partin table nomogram AUC 78%
Conclusions; CT scan can detect LNI in low risk group but benefit was limited. We concluded that CT could be more benefit in intermediate to high risk prostate cancer for detecting LN metastasis and predictive normogram could be accepted in accuracy
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