Diagnostic Efficacy of 68Gallium-PSMA Positron Emission Tomography Compared to Conventional Imaging for Lymph Node Staging of 130 Consecutive Patients with Intermediate to High Risk Prostate Cancer
Diagnostic Efficacy of 68Gallium-PSMA Positron Emission Tomography Compared to Conventional Imaging for Lymph Node Staging of 130 Consecutive Patients with Intermediate to High Risk Prostate Cancer
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DOI：
10.1016/j.juro.2015.12.025
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发表时间：
2016-05-01
影响因子：
6.6
通讯作者：
Eiber, Matthias
中科院分区：
文献类型：
--
作者：
Maurer, Tobias;Gschwend, Juergen E.;Eiber, Matthias
目的：目前的标准成像技术不足以可靠地检测前列腺癌的淋巴结转移。近年来，前列腺特异性膜抗原（PSMA）的配体被引入到前列腺癌的正电子发射断层扫描（PET）中。因此，本回顾性分析的目的是：1）研究68 Ga-PSMA-PET成像对计划行根治性前列腺癌切除术的前列腺癌患者淋巴结分期的诊断有效性，2）将其与形态学成像进行比较（计算机断层扫描和磁共振断层扫描）与组织病理学评价作为参考标准。2012年12月至2014年11月，在根治性前列腺切除术和模板盆腔淋巴结清扫术之前，共对130例中高危前列腺癌患者进行了68 Ga-PSMA-PET/磁共振断层扫描或PET/计算机断层扫描分期。切除组织的组织学表现与68 Ga-PSMA-PET和形态学成像的结果在患者和模板为基础的manners.Results的结果有统计学相关性：淋巴结转移被发现在41 130例（31.5%）。以患者为基础分析，68 Ga-PSMA-PET诊断乳腺癌的敏感性、特异性和准确性分别为65.9%、98.9%和88.5%，形态学显像的敏感性、特异性和准确性分别为43.9%、85.4%和72.3%。在734个清扫的淋巴结模板中，117个（15.9%）显示转移。基于模板分析，68 Ga-PSMA-PET的敏感性、特异性和准确性分别为68.3%、99.1%和95.2%，形态学成像的敏感性、特异性和准确性分别为27.3%、97.1%和87.6%。在ROC分析中，Ga-68-PSMA-PET在患者和基于模板的分析中的表现明显优于单独的形态学成像（分别为p = 0.002和< 0.001）。结论：在具有中高风险前列腺癌的患者中，Ga-68-PSMA-PET的术前淋巴结分期被证明上级标准常规成像。因此，如果通过前瞻性研究证实，它有可能取代目前用于该适应症的标准成像。
Purpose: Current standard imaging techniques are insufficient to reliably detect lymph node metastases in prostate cancer. Recently ligands of PSMA (prostate specificmembrane antigen) were introduced in PET (positron emission tomography) of prostate cancer. Thus the aims of this retrospective analysis were to 1) investigate the diagnostic efficacy of 68 Ga-PSMA-PET imaging for lymph node staging in patients with prostate cancer scheduled for radical prostatectomy and 2) compare it to morphological imaging (computerized tomography and magnetic resonance tomography) with histopathological evaluation as the standard of reference.Materials and Methods: A total of 130 patients with intermediate to high risk prostate cancer were staged with 68 Ga-PSMA-PET/magnetic resonance tomography or PET/computerized tomography from December 2012 to November 2014 before radical prostatectomy and template pelvic lymph node dissection. Histopathological findings of resected tissue were statistically correlated with the results of 68 Ga-PSMA-PET and morphological imaging in a patient and template based manner.Results: Lymph node metastases were found in 41 of 130 patients (31.5%). On patient based analysis the sensitivity, specificity and accuracy of 68 Ga-PSMA-PET were 65.9%, 98.9% and 88.5%, and those of morphological imaging were 43.9%, 85.4% and 72.3%, respectively. Of 734 dissected lymph node templates 117 (15.9%) showed metastases. On template based analysis the sensitivity, specificity and accuracy of 68 Ga-PSMA-PET were 68.3%, 99.1% and 95.2%, and those of morphological imaging were 27.3%, 97.1% and 87.6%, respectively. On ROC analysis Ga-68-PSMA-PET performed significantly better than morphological imaging alone on patient and template based analyses (p = 0.002 and < 0.001, respectively).Conclusions: In patients with intermediate to high risk prostate cancer preoperative lymph node staging with Ga-68-PSMA-PET proved to be superior to standard routine imaging. Thus it has the potential to replace current standard imaging for this indication if confirmed by prospective studies.