Diagnostic accuracy of multiparametric magnetic resonance imaging for pelvic lymph node metastasis in prostate cancer

Abstract

Prostate cancer (PCa) is the second most common cancer in men, and can be detected through various modalities. Magnetic resonance imaging (MRI) is a good imaging modality for PCa detection, localization, and staging. This study evaluates the role of multiparametric MRI in detecting lymph node metastasis in PCa patients. A prospective study was conducted at Erbil urology center/in Iraq, targeting patients planning to have a radical prostatectomy with pelvic lymphadenectomy between April 2022 and December 2022. This study included 30 patients diagnosed with PCa; every patient underwent both preoperative MRI of the prostate and radical prostatectomy with extended pelvic lymph node dissection. MRI findings and histopathology results were compared for accuracy. Nodal metastasis was detected in 6/30 (20%) of cases. Overall, 6/30 (20%) had enlarged pelvic lymph nodes shown on MRI. Enlarged internal iliac lymph nodes were most common, found in 4/6 (66.7%) patients. There was a slight agreement between MRI T-stage and pathological T-stage (Kappa= 0.179, p=0.08). Lymph node enlargement on MRI showed moderate accuracy (area under the curve [AUC] = 0.708), with sensitivity and positive predictive value of 66.7% and specificity and negative predictive value of 91.7%. Although the predictor was significantly associated with lymph node metastasis (log-odds ratio = 0.012, p = 0.01), its ability to distinguish patients with nodal involvement from those without was moderate (AUC = 0.708). This study suggests that preoperative MRI parameters, when combined with clinical features, may have limited value in predicting nodal metastases.

Keywords

Prostate-specific antigen / Prostate cancer / Extended pelvic lymph node dissection

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