Detection of Lymph Node Metastasis in Patients with Nodal Prostate Cancer Relapse Using 18F/11C-Choline Positron Emission Tomography/Computerized Tomography
Detection of Lymph Node Metastasis in Patients with Nodal Prostate Cancer Relapse Using 18F/11C-Choline Positron Emission Tomography/Computerized Tomography
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DOI：
10.1016/j.juro.2013.12.054
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发表时间：
2014-07-01
影响因子：
6.6
通讯作者：
Rischke, H. Christian
中科院分区：
文献类型：
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作者：
Jilg, Cordula A.;Schultze-Seemann, Wolfgang;Rischke, H. Christian
目的：根据淋巴结的地形位置和肿瘤浸润大小，评价胆碱正电子发射断层扫描/计算机断层扫描对前列腺癌淋巴结复发的诊断准确性。材料与方法：72例原发性前列腺癌复发患者行盆腔和/或腹膜后补救性淋巴结清扫术。全身正电子发射断层扫描/c -11-胆碱或f -18-氟乙基胆碱计算机断层扫描显示正电子发射断层扫描阳性淋巴结，但没有其他可检测到的转移。对160个淋巴结清扫区（骨盆左/右和腹膜后）、498个亚区（普通、髂内外、闭孔、骶前、主动脉分叉、主动脉、腔静脉和腔动脉间）和2122个淋巴结的诊断准确性进行了评估。结果：2122例切除淋巴结中有681例（32%）出现淋巴结转移，阳性亚区238个，阳性区111个。正电子发射断层扫描/计算机断层扫描在110个区域和209个亚区呈阳性。敏感性、特异性、阳性预测值和阴性预测值分别为91.9%、83.7%、92.7%、82.0%和89.4%（基于区域），80.7%、93.5%、91.9%、84.1%和87.3%（基于次区域），57.0%、98.4%、94.5%、82.6%和84.9%（基于病变）。该方法检出的393例阳性淋巴结转移灶中，短轴直径小于10 mm的淋巴结占278例（70.7%）。肿瘤浸润深度2 ~小于3mm、5 ~小于6mm、10 ~小于11mm的影像敏感性分别为13.3%、57.4%和82.8%。淋巴结转移部位和放射性示踪剂（c -11-胆碱/ f -18-氟乙基胆碱）对诊断准确性没有实质性影响。结论：胆碱正电子发射断层扫描/计算机断层扫描对前列腺癌复发患者受累淋巴结区（骨盆左/右及腹膜后）的检测准确率较高，有助于指导补救性淋巴结清扫。敏感性随淋巴结转移浸润的大小而降低。该技术可在计算机断层扫描未病理放大的淋巴结中检测转移。
Purpose: We evaluated the diagnostic accuracy of choline positron emission tomography/computerized tomography for nodal relapse of prostate cancer according to topographical site and tumor infiltration size in lymph nodes.Materials and Methods: A total of 72 patients with nodal prostate cancer relapse after primary therapy underwent pelvic and/or retroperitoneal salvage lymph node dissection. Salvage was done after whole body positron emission tomography/computerized tomography with C-11-cholineor F-18-fluoroethylcholine showed positron emission tomography positive lymph nodes but no other detectable metastasis. Diagnostic accuracy was evaluated in 160 dissected lymph node regions (pelvic left/right and retroperitoneal), 498 subregions (common, external and internal iliac, obturator, presacral, aortic bifurcation, aortal, vena caval and interaortocaval) and 2,122 lymph nodes.Results: Lymph node metastasis was present in 32% of resected lymph nodes (681 of 2,122), resulting in 238 positive subregions and 111 positive regions. Positron emission tomography/computerized tomography was positive for 110 regions and 209 subregions. Sensitivity, specificity, positive and negative predictive values, and accuracy were 91.9%, 83.7%, 92.7%, 82.0% and 89.4% (region based), 80.7%, 93.5%, 91.9%, 84.1% and 87.3% (subregion based), and 57.0%, 98.4%, 94.5%, 82.6% and 84.9% (lesion based), respectively. Of 393 positive lymph node metastases detected by this method 278 (70.7%) were in lymph nodes with a less than 10 mm short axis diameter. Imaging sensitivity was 13.3%, 57.4% and 82.8% for a tumor infiltration depth of 2 or greater to less than 3 mm, 5 or greater to less than 6 mm and 10 or greater to less than 11 mm, respectively. Lymph node metastasis site and the radiotracer (C-11-choline/F-18-fluoroethylcholine) had no substantial impact on diagnostic accuracy.Conclusions: Choline positron emission tomography/computerized tomography detects affected lymph node regions (pelvic left/right and retroperitoneal) in patients with prostate cancer relapse with high accuracy and it seems helpful for guiding salvage lymph node dissection. Sensitivity decreases with the size of metastatic infiltration in lymph nodes. This technique detects metastasis in a significant fraction of lymph nodes that are not pathologically enlarged on computerized tomography.