MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study

Heesakkers, Roel AM; Hövels, Anke M; Jager, Gerrit J; van den Bosch, Harrie CM; Witjes, J Alfred; Raat, Hein PJ; Severens, Johan L; Adang, Eddy MM; van der Kaa, Christina Hulsbergen; Fütterer, Jurgen J; Barentsz, Jelle

doi:10.1016/s1470-2045(08)70203-1

Cited by 307Prostate Cancer Diagnosis and TreatmentMRI in cancer diagnosisMedical Imaging Techniques and Applications

MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study

Heesakkers, Roel AM, Hövels, Anke M, Jager, Gerrit J, van den Bosch, Harrie CM, Witjes, J Alfred, Raat, Hein PJ, Severens, Johan L, Adang, Eddy MM +3 more·2008·The Lancet Oncology

DOI 10.1016/s1470-2045(08)70203-1

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Abstract

Background In patients with prostate cancer who are deemed to be at intermediate or high risk of having nodal metastases, invasive diagnostic pelvic lymph-node dissection (PLND) is the gold standard for the detection of nodal disease. However, a new lymph-node-specific MR-contrast agent ferumoxtran-10 can detect metastases in normal-sized nodes (ie, <8 mm in size) by use of MR lymphoangiography (MRL). In this prospective, multicentre cohort study, we aimed to compare the diagnostic accuracy of MRL with up-to-date multidetector CT (MDCT), and test the hypothesis that a negative MRL finding obviates the need for a PLND.Methods We included consecutive patients with prostate cancer who had an intermediate or high risk (risk of >5% according to routinely used nomograms) of having lymph-node metastases. All patients were assessed by MDCT and MRL, and underwent PLND or fine-needle aspiration biopsy. Imaging results were correlated with histopathology. The primary outcomes were sensitivity, specificity, accuracy, NPV, and PPV of MRL and MDCT. This study is registered with ClinicalTrials.gov, number NCT00185029.Findings The study was done in 11 hospitals in the Netherlands between April 8, 2003, and April 19, 2005. 375 consecutive patients were included. 61 of 375 (16%) patients had lymph-node metastases. Sensitivity was 34% (21 of 61; 95% CI 23-48) for MDCT and 82% (50 of 61; 70-90) for MRL (McNemar's test p<0.05). Specificity was 97% (303 of 314; 94-98) for MDCT and 93% (291 of 314; 89-95) for MRL. Positive predictive value (PPV) was 66% (21 of 32; 47-81) for MDCT and 69% (50 of 73; 56-79) for MRL. Negative predictive value (NPV) was 88% (303 of 343; 84-91) for MDCT and 96% (291 of 302; 93-98) for MRL (McNemar's test p<0.05). Of the 61 patients with lymph-node metastases, 50 were detected by MRL, of which 40 (80%) had metastases in normal-sized lymph nodes. The high sensitivity and NPV of MRL imply that in patients with a negative MRL, the chance of positive lymph nodes is less than 11/302 (4%).Interpretation MRL had significantly higher sensitivity and NPV than MDCT for patients with prostate cancer who had intermediate or high risk of having lymph-node metastases. In such patients, after a negative MRL, the post-test probability of having lymph-node metastases is low enough to omit a PLND.

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In a multicenter clinical trial, contrast-enhanced MR lymphography produced mixed results, arguably due to differences in radiologist experience and expertise.
“In a multicenter clinical trial, the clinical effectiveness of contrast-enhanced MR lymphography was evaluated, producing mixed results, arguably originating from differences in the experience and expertise of the radiologists involved [162].”
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Imaging Biochemical Recurrence After Prostatectomy: Where Are We Headed?
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The importance of the extent of pelvic-lymph-node dissection in the diagnosis of lymph-node metastases in prostate cancer
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MRL can accurately detect nodal metastases in patients with prostate cancer
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Laparoscopic pelvic lymph node dissection allows significantly more accurate staging in “high‐risk” prostate cancer compared to MRI or CT
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Prostate Cancer: Detection of Lymph Node Metastases Outside the Routine Surgical Area with Ferumoxtran-10–enhanced MR Imaging
Heesakkers, R. A. M., Jager, G. J., Hövels, A. M., de Hoop, B., van den Bosch, H. C. M., Raat, F., Witjes, J. A., Mulders, P., van der Kaa, C. H., & Barentsz, J. O. (2009) · Radiology · doi:10.1148/radiol.2512071018 · Cited by 132 · see citing works
Self-citation

Authors: Heesakkers, R. A., Hövels, A. M., Jager, G. J., van den Bosch, H. C., Witjes, J. A., Raat, H. P., Severens, J. L., Adang, E. M., van der Kaa, C. H., Fütterer, J. J., & Barentsz, J.
Affiliations: Radboud University Medical Center (NL)
Jeroen Bosch Ziekenhuis (NL)
ZorgSaam (NL)
Maastricht University Medical Centre (NL)
Corresponding author: Barentsz, Jelle
ORCID: Hövels, Anke M
Witjes, J Alfred
Raat, Hein PJ
Severens, Johan L
Adang, Eddy MM
Fütterer, Jurgen J
Barentsz, Jelle
Venue: The Lancet Oncology
Publisher: Elsevier BV
Published: 2008-09
Volume: 9
Issue: 9
Pages: 850-856
ISSN: 1470-2045 (ISSN-L)
DOI: 10.1016/s1470-2045(08)70203-1
OpenAlex: W2124586180
Cited by: 307
References: 40
Citations by year: 2026: 2 · 2025: 7 · 2024: 6 · 2023: 9 · 2022: 13 · 2021: 10 · 2020: 16 · 2019: 21 · 2018: 22 · 2017: 19 · 2016: 22 · 2015: 19 · 2014: 21 · 2013: 27 · 2012: 26
FWCI: 19.89
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The Lancet Oncology (publishedVersion)
PubMed (publishedVersion)
Radboud Repository (Radboud University) (submittedVersion)
Funders: Radboud Universiteit
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Diagnosis and Treatment
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › MRI in cancer diagnosis
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
Keywords: prostate cancer, pelvic lymph node metastasis, MR lymphography, ferumoxtran-10, pelvic lymphadenectomy, multidetector computed tomography, diagnostic accuracy, intermediate- and high-risk prostate cancer, fine-needle aspiration, lymph node staging, negative predictive value, sensitivity and specificity, cost-effectiveness, quality of life
MeSH terms: Aged, Aged, 80 and over, Contrast Media, Dextrans, Humans, Iron, Lymph Node Excision, Lymphatic Metastasis, Male, Middle Aged, Oxides, Predictive Value of Tests, Prostatic Neoplasms, Sensitivity and Specificity, Tomography, X-Ray Computed, Echo-Planar Imaging, Ferrosoferric Oxide, Magnetite Nanoparticles

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MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study

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