The use and accuracy of cross-sectional imaging and fine needle aspiration cytology for detection of pelvic lymph node XXXX before radical prostatectomy.

@entity1 @entity263 @entity3
The role of cross-sectional pelvic imaging with computerized tomography or magnetic resonance imaging and fine needle aspiration in the assessment of pelvic lymph nodes in @entity1 with @entity263 is undefined. To address this issue we used formal decision analysis, comparing an imaging arm to a no imaging arm. @entity1 utility values were calculated, and test parameters and complication rates were extracted from the literature. Imaging was superior to no imaging only when the pretest probability of pelvic lymph node @entity3 was high. The most important parameter was the sensitivity of cross-sectional imaging for lymphadenopathy. When the sensitivity was 36%, which was the baseline figure derived from the literature, the probability of lymph node @entity3 required for imaging to be beneficial overall was 32%. We also performed a retrospective review of magnetic resonance imaging examinations at our institution in 174 @entity1 with newly diagnosed @entity263 and pathological confirmation of nodal status. The sensitivity for detecting nodal @entity3 was 25%. With this figure, the estimated probability of nodal @entity3 required to make imaging beneficial would be 45%, which is possible to achieve with highly selective clinical criteria. With a policy of imaging only in select @entity1 the marginal cost is  794 per @entity1 benefited (aborted radical prostatectomy because of nodal @entity3 detected with fine needle aspiration) compared to  50,661 per @entity1 benefited if all @entity1 are imaged. Thus, cross-sectional pelvic imaging before radical prostatectomy, solely for the purpose of detecting pelvic lymph node @entity3 , is not justified routinely. However, it is worthwhile on the basis of @entity1 use values and cost-effectiveness in a select group of @entity1 at high risk for nodal @entity3 .
