68Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is68Ga-PSMA PET/CT guided biopsy the future?
68Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is68Ga-PSMA PET/CT guided biopsy the future?
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DOI：
10.1007/s00259-019-04620-0
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发表时间：
2020-07-01
影响因子：
9.1
通讯作者：
Roberts, Matthew J.
中科院分区：
文献类型：
--
作者：
Donato, Peter;Morton, Andrew;Roberts, Matthew J.
背景 68Ga 前列腺特异性膜抗原 PET/CT (68Ga-PSMA PET/CT) 在定位前列腺癌肿瘤病灶方面可能优于多参数 MRI (mpMRI)，但 68Ga-PSMA PET/CT 和 mpMRI 应用于所有活检患者时的一致性和差异以及对 mpMRI 阴性患者的潜在益处尚不清楚。方法 对 3 年期间接受 mpMRI、前列腺活检和 68Ga-PSMA PET/CT 的患者进行回顾性分析。使用整个队列的活检组织病理学和一部分患者的根治性前列腺切除标本评估 68Ga-PSMA PET/CT 和 mpMRI 的诊断性能。确定了每种方式的病变一致性和额外检测，包括在使用 mpMRI PIRADS 2 扫描的专门患者队列中。结果共有144名患者纳入研究。 68Ga-PSMA PET/CT 和 mpMRI 的指数病灶/病灶检测相似（灵敏度 83.1% vs 90.1%；p = 0.267），但 mpMRI 漏检的病灶更大（1.66 cm(3) vs 0.72 cm(3)；p = 0.034）。活检组织病理学和根治性前列腺切除术标本子集的病变检出率相似，两种成像方式之间的指数高度一致性（80.1%），总病变程度中等一致性（67%）。对于指数病灶（13.5% vs 4.3%）和总病灶（18.2% vs 5.4%），68Ga-PSMA PET/CT 的额外检测率优于 mpMRI；两种方法分别漏诊了 2.1% 和 12.3% 的指数病灶和总病灶。 68Ga-PSMA PET/CT 识别出 11 名患者中的 9 名患有 PIRADS 2 mpMRI，但随后诊断为 Gleason >= 3 + 4 疾病。结论 尽管一致性率很高，但与 mpMRI 相比，68Ga-PSMA PET/CT 逐渐改善了肿瘤定位。这些结果表明，68Ga-PSMA PET/CT 在前列腺诊断过程中可能比 mpMRI 具有增量价值。
Background 68Ga prostate specific membrane antigen PET/CT (68Ga-PSMA PET/CT) may be superior to multiparametric MRI (mpMRI) for localisation of prostate cancer tumour foci, however the concordance and differences between 68Ga-PSMA PET/CT and mpMRI when applied to all biopsied patients and potential benefit in patients with negative mpMRI is unclear. Methods Retrospective analysis of patients undergoing mpMRI, prostate biopsy and 68Ga-PSMA PET/CT over a 3-year period. Diagnostic performance of 68Ga-PSMA PET/CT and mpMRI were assessed using biopsy histopathology for the entire cohort and radical prostatectomy specimen in a subset of patients. Lesion concordance and additional detection of each modality were determined, including in a dedicated cohort of patients with mpMRI PIRADS 2 scans. Results A total of 144 patients were included in the study. Index lesion/foci detection was similar between 68Ga-PSMA PET/CT and mpMRI (sensitivity 83.1% vs 90.1%;p = 0.267), however lesions missed by mpMRI were larger (1.66 cm(3)vs 0.72 cm(3);p = 0.034). Lesion detection rates were similar across the biopsy histopathology and radical prostatectomy specimen subset, with a high concordance for index (80.1%) and a moderate concordance for total (67%) lesions between the 2 imaging modalities. The additional detection yield favoured 68Ga-PSMA PET/CT over mpMRI for index (13.5% vs 4.3%) and total (18.2% vs 5.4%) lesions; both modalities missed 2.1% and 12.3% of index and total lesions, respectively. 68Ga-PSMA PET/CT identified 9 of 11 patients with PIRADS 2 mpMRI but subsequently diagnosed with Gleason >= 3 + 4 disease. Conclusions Despite high concordance rates, 68Ga-PSMA PET/CT incrementally improved tumour localisation compared with mpMRI. These results suggest that 68Ga-PSMA PET/CT may have an incremental value to that of mpMRI in the diagnostic process for prostate.