The 2018 Briganti nomogram: the probability of lymph node invasion (LNI) for patients diagnosed with MRI-targeted and systematic biopsies
The current model predicts the probability of pelvic lymph node involvement for patients with local Clinically Localized Prostate Cancer Diagnosed with Magnetic Resonance Imaging-targeted and Systematic Biopsies

The current model is applicable exclusively to men with a positive MRI-targeted biopsy with concomitant systematic biopsy, as currently indicated by guidelines. Moreover, the risk of LNI should not be estimated using this model for individuals who were diagnosed via systematic biopsy with a negative MRI-targeted biopsy. For these patients, predictive tools developed using data for men diagnosed with systematic biopsy such as the Briganti 2012, Briganti 2017, and MSKCC nomograms are more suitable.
Research authors: Giorgio Gandaglia, Guillaume Ploussard, Massimo Valerio, Agostino Mattei, Cristian Friori, Nicola Fossati, Armando Stabile, Jean-Baptiste Beauval, Bernard Malavaud, Mathieu Roumiguié, Daniele Robesti, Paolo Dell'Oglio, Marco Moschini, Stefania Zamboni, Arnas Rakauskas, Francesco De Cobelli, Francesco Porpiglia, Francesco Montorsi, Alberto Briganti
Details Formula Study characteristics Files & References
★★★★
Model author
Model ID
1555
Version
1.4
Revision date
2018-10-23
Specialty
MeSH terms
  • Prostate Cancer
  • Lymphadenectomy
  • Model type
    Logistic regression (Calculation)
    Status
    public
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    Formula
    No Formula defined yet
    Condition Formula

    Additional information

    After institutional review board approval, 581 patients who underwent MRI-targeted biopsy and radical prostatectomy (RP) with extended Pelvic Lymph Node Dissection (ePLND) between 2016 and 2018 at five European tertiary referral centers were retrospectively identified. mpMRI and MRI-targeted biopsies were routinely recommended to patients with a clinical suspicion of PCa according to the judgment of the treating physician. Only patients with a positive MRI-targeted biopsy were selected (n = 516). Among those, patients with incomplete biopsy or pathologic data (n = 19) were excluded. This resulted in a final population of 497 patients.

    No patients received neoadjuvant hormonal therapy. Surgery was routinely proposed as a treatment option at each center. The decision to perform RP was left to the clinical judgment of the treating physician after discussion with each patient regarding the potential benefits and side effects of all available treatment modalities for the management of localized PCa. Only patients who underwent anatomically defined ePLND with removal of the obturator, internal iliac, and external iliac lymph nodes were included. All procedures were performed by high-volume surgeons at referral institutions. All specimens were submitted for pathologic evaluation in multiple packages and were evaluated by dedicated uropathologists.

    Study Population

    Total population size: 497
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name LL Q1 Median Q3 UL Unit
    Age at surgery (pN0 patients) 60 65 70 years
    Age at surgery (pN1 patients) 60 64 71 years
    Preoperative PSA (pN0 patients) 5.1 7.2 11 ng/ml
    Preoperative PSA (pN1 patients) 6.7 11 21 ng/ml
    Prostate volume (pN0 patients) 33 43 55 ml
    Prostate volume (pN1 patients) 34 48 59 ml
    Maximum index lesion diameter on mpMRI (pN0 patients) 9 10 14 mm
    Maximum index lesion diameter on mpMRI 10 15 18 mm
    Cores taken overall (pN0 patients) 14 16 18 cores
    Cores taken overall (pN1 patients) 14 16 18 cores
    Positive cores overall (pN0 patients) 3 5 8 cores
    Positive cores overall (pN1 patients) 9 5 12 cores
    Percentage of positive cores overall (pN0 patients) 20 33 50 %
    Percentage of positive cores overall (pN1 patients) 36 55 80 %
    Positive cores with highest-grade PCa (pN0 patients) 12 20 38 %
    Positive cores with highest-grade PCa (pN1 patients) 24 40 60 %
    Positive cores with lower-grade PCa (pN0 patients) 8 16 27 %
    Positive cores with lower-grade PCa (pN1 patients) 10 21 30 %
    Systematic cores taken (pN0 patients) 10 12 15 cores
    Systematic cores taken (pN1 patients) 10 12 16 cores
    Cores with csPCa on systematic biopsy (pN0 patients) 0 12 37 %
    Cores with csPCa on systematic biopsy (pN1 patients) 17 42 76 %
    Lymph nodes removed (pN0 patients) 10 15 20 nodes
    Lymph nodes removed (pN1 patients) 13 17 24 nodes
    Positive lymph nodes 1 1 2 nodes

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Lymph node involvement pN0 435
    pN1 62
    Clinical stage (pN0 patients) T1 335
    T2 96
    T3 4
    Clinical stage (pN1 patients) T1 30
    T2 21
    T3 11
    PI-RADS score (pN0 patients) 3 121
    4 235
    5 79
    PI-RADS score (pN1 patients) 3 4
    4 26
    5 32
    Number of PI-RADS ≥3 lesions on mpMRI (pN0 patients) 1 299
    2 91
    3 27
    ≥4 18
    Number of PI-RADS ≥3 lesions on mpMRI (pN1 patients) 1 38
    2 20
    3 3
    ≥4 1
    Clinical stage on mpMRI (pN0 patients) Organ-confined 358
    Extracapsular extension 49
    Seminal vesicle invasion 13
    Clinical stage on mpMRI (pN1 patients) Organ-confined 29
    Extracapsular extension 19
    Seminal vesicle invasion 14
    Biopsy grade group overall (pN0 patients) 1 55
    2 236
    3 78
    4 45
    5 21
    Biopsy grade group overall (pN1 patients) 1 1
    2 15
    3 16
    4 15
    5 15
    Grade group on MRI-targeted biopsy (pN0 patients) 1 72
    2 225
    3 72
    4 46
    5 20
    Grade group on MRI-targeted biopsy (pN1 patients) 1 1
    2 15
    3 16
    4 17
    5 13
    Target cores taken on MRI-targeted biopsy (pN0 patients) 2 165
    3 94
    4 77
    ≥5 99
    Target cores taken on MRI-targeted biopsy (pN1 patients) 2 27
    3 18
    4 10
    ≥5 7
    Positive cores on MRI-targeted biopsy (pN0 patients) 1 111
    2 173
    3 69
    ≥4 82
    Positive cores on MRI-targeted biopsy (pN1 patients) 1 5
    2 32
    3 16
    ≥4 9
    Grade group on systematic biopsy (pN0 patients) Negative 80
    1 100
    2 171
    3 44
    4 25
    5 15
    Grade group on systematic biopsy (pN1 patients) Negative 4
    1 6
    2 14
    3 15
    4 9
    5 14
    Surgical technique Open 43
    Robot-assisted 454
    Gleason grade group on final pathology (pN0 patients) 1 15
    2 218
    3 147
    4 22
    5 30
    Gleason grade group on final pathology (pN1 patients) 1 0
    2 3
    3 25
    4 4
    5 30
    Pathologic stage (pN0 patients) pT2 215
    pT3a 180
    pT3b/pT4 40
    Pathologic stage (pN1 patients) pT2 3
    pT3a 20
    pT3b/pT4 39
    Positive surgical margins pN0 patients 103
    pN1 patients 40

    Related files

    The calculated risk of Lymph Node Involvement is:
    ...

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    Result
    Note
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    The calculated risk of Lymph Node Involvement is:

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    Outcome stratification

    Result interval {{ additionalResult.min }} to {{ additionalResult.max }}

    Conditional information

    Result interpretation

    Adoption of this model using a 7% cutoff would avoid approximately 60% of ePLND procedures at the cost of missing only 1.6% of LNI cases.

    {{ file.classification }}

    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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