To explore the evidence and knowledge gaps in sentinel node biopsy (SNB) in prostate cancer by a consensus panel of experts.
A two-round Delphi survey among experts was followed by a consensus panel meeting of 16 experts in February 2016. Agreement voting was performed using the RAND/University of California, Los Angeles Appropriateness Methodology on 150 statements in 9 domains. The disagreement index based on the interpercentile range-adjusted for symmetry score was used to assess consensus and non-consensus among panel members
Consensus was obtained on 91 of 150 (61%) statements. Main outcomes were: 1. The results from an extended lymph node dissection (eLND) are still considered the gold standard and SN detection should be combined with eLND at least in intermediate and high risk prostate cancer patients; 2. The role of SN detection in low risk prostate cancer is unclear; 3. Future studies should contain oncological endpoints as number of positive nodes outside the eLND template, false negative and false positive SN procedures, and recurrence-free survival. A high rate of consensus was obtained regarding outcome measures of future clinical trials on SNB (89%). Consensus on tracer technology was only obtained in 47% of statements reflecting a need for further research and standardization in this area.
The low level evidence in the available literature and the composition of mainly SN users in the panel constitute the major limitations of the study.
Consensus on a majority of elementary statements on SN detection in prostate cancer was obtained. Therefore the results from this consensus report will provide a basis for the design of further studies in the field.
We thank all contibutors to the Delphi Survey for their input, as well as the companies Karl Storz Endoskope (Germany) and Intuitive Surgical (USA) for making the consensus meeting possible.
- consensus meeting report
- sentinel node biopsy
- extended lymph node dissection
- #prostate cancer