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Imaging Studies
- Prediction of lymph node status can help in preoperative staging. CT scanning is used most commonly for this purpose.
- This imaging modality has been evaluated in numerous studies looking at pelvic lymph node metastases in bladder cancer.3
- Studies by several groups have found sensitivities of detecting pelvic lymph node metastases ranging from 10-94%, for a cumulative sensitivity of only 48%. However, when detected, nodal enlargement is specific, with a range of 83-100%, for a cumulative specificity of 94%.
- Approximately 40% of cases are understaged, and approximately 5% are overstaged.
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References
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Vieweg J, Whitmore WF Jr, Herr HW, Sogani PC, Russo P, Sheinfeld J, et al. The role of pelvic lymphadenectomy and radical cystectomy for lymph node positive bladder cancer. The Memorial Sloan-Kettering Cancer Center experience. Cancer. Jun 15 1994;73(12):3020-8. [Medline].
Paik ML, Scolieri MJ, Brown SL, et al. Limitations of computerized tomography in staging invasive bladder cancer before radical cystectomy. J Urol. Jun 2000;163(6):1693-6. [Medline].
Messing EM, Manola J, Sarosdy M, Wilding G, Crawford ED, Trump D. Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med. Dec 9 1999;341(24):1781-8. [Medline].
Pilepich MV, Krall JM, al-Sarraf M, John MJ, Doggett RL, Sause WT, et al. Androgen deprivation with radiation therapy compared with radiation therapy alone for locally advanced prostatic carcinoma: a randomized comparative trial of the Radiation Therapy Oncology Group. Urology. Apr 1995;45(4):616-23. [Medline].
Abeloff MD, Armitage JO, Lichter AS, Niederhuber JE, eds. Urethral Carcinoma. In: Clinical Oncology. 2nd ed. St Louis, Mo: Churchill Livingstone; 2000.
Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff RO, Storme G, et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med. Jul 31 1997;337(5):295-300. [Medline].
Carter H, Partin AW. Diagnosis and Staging of Prostate Cancer. In: Walsh PC, Retik AB, Vaughn ED, Wein AJ, eds. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:2519-37.
Granfors T, Modig H, Damber JE, Tomic R. Combined orchiectomy and external radiotherapy versus radiotherapy alone for nonmetastatic prostate cancer with or without pelvic lymph node involvement: a prospective randomized study. J Urol. Jun 1998;159(6):2030-4. [Medline].
Hinman F. Pelvic Lymphadenectomy. In: Hinman F, ed. Atlas of Urologic Surgery. 2nd ed. Philadelphia, Pa: WB Saunders; 1998:517-24.
Hinman F. Modified Pelvic Lymph Node Dissection, Laparoscopic and Minilaparotomy Pelvic Lymph Node Dissection. In: Hinman F, ed. Atlas of Urologic Surgery. 2nd ed. Philadelphia, Pa: WB Saunders; 1998:465-75.
Janetschek G. Pelvic lymph node dissection in prostate cancer: editorial review. Curr Opin Urol. Mar 2005;15(2):65-7. [Medline].
Koppie TM, Vickers AJ, Vora K, Dalbagni G, Bochner BH. Standardization of pelvic lymphadenectomy performed at radical cystectomy: can we establish a minimum number of lymph nodes that should be removed?. Cancer. Nov 15 2006;107(10):2368-74. [Medline].
Messing EM, Catalona W. Urothelial Tumors of the Urinary Tract. In: Walsh PC, Retik AB, Vaughn ED, Wein AJ, eds. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:2327-2410.
Mills RD, Fleischmann A, Studer UE. Radical cystectomy with an extended pelvic lymphadenectomy: rationale and results. Surg Oncol Clin N Am. Jan 2007;16(1):233-45. [Medline].
Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KJ, Oesterling JE, et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA. May 14 1997;277(18):1445-51. [Medline].
Stein JP. The role of lymphadenectomy in patients undergoing radical cystectomy for bladder cancer. Curr Oncol Rep. May 2007;9(3):213-21. [Medline].
Stein JP, Penson DF, Cai J, Miranda G, Skinner EC, Dunn MA, et al. Radical cystectomy with extended lymphadenectomy: evaluating separate package versus en bloc submission for node positive bladder cancer. J Urol. Mar 2007;177(3):876-81; discussion 881-2. [Medline].
Further Reading
Keywords
pelvic lymphadenectomy, lymph node dissection, pelvic lymph node dissection, PLND, bladder cancer, prostate cancer, urethral cancer, penile cancer, genitourinary cancer
Workup: Lymph Node Dissection, Pelvic