Objective
Decide, based on quantitative risk and guidelines, whether ePLND should be performed — and justify the decision with RCT evidence.
Clinical scenario
Extended lymph node dissection improves staging but adds morbidity. The question is objective: does this patient's risk of lymph node invasion justify the procedure?
Step by step in the app
- 1
Ensure the input data
PSA, clinical stage, ISUP grade group and the percentage of high-grade cores must be filled in — these are the Briganti variables.
- 2
Open the Lymph Node Dissection (PLND)
In the More menu, open the PLND module. The app computes the probability of lymph node invasion.
- 3
Compare against the thresholds
The system applies the 7% (Briganti) and 5% (EAU) thresholds and recommends performing or omitting the ePLND.
- 4
Explore the regional list
See the probability per lymph node chain (e.g., right/left obturator) and the estimated number of lymph nodes in the template.
- 5
Open the XAI panel
Understand how much each factor (PSA, stage, ISUP, % high-grade cores) contributed to the risk.
- 6
Contextualize with the RCTs
Read the interpretation of the randomized trials by ISUP/LNI subgroup before finalizing the plan.
Clinical pearls
- Risk below 5% rarely justifies the morbidity of ePLND — the app makes this explicit.
- The regional list helps plan the template, not just the binary decision of whether to operate.
- The built-in RCT reading keeps the decision from relying on the nomogram alone.
References
- Briganti/Gandaglia 2017 (AUC 90.8%)
- Roscigno et al. 2018
- Lestingi et al. 2021 (phase III)