Prospective evaluation of the performance of [68Ga]Ga-PSMA-11 PET/CT(MRI) for lymph node staging in patients undergoing superextended salvage lymph node dissection after radical prostatectomy
Prospective evaluation of the performance of [68Ga]Ga-PSMA-11 PET/CT(MRI) for lymph node staging in patients undergoing superextended salvage lymph node dissection after radical prostatectomy
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DOI：
10.1007/s00259-019-04361-0
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发表时间：
2019-09-01
影响因子：
9.1
通讯作者：
Hartenbach, Markus
中科院分区：
文献类型：
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作者：
Abufaraj, Mohammad;Grubmueller, Bernhard;Hartenbach, Markus
目的评价[Ga-68]-PSMA-11 PET/CT或[Ga-68]-PSMA-11 PET/MRI （PSMA-11 PET/CT(MRI)）对根治性前列腺切除术（RP）后生化复发（BCR）患者淋巴结清扫（SLND）分期的准确性。患者和方法在一项前瞻性研究中，在2014年至2018年期间，65例RP后发生BCR的患者连续在PSMA-11 PET/CT（MRI）后接受SLND。所有患者均行延伸SLND至肠系膜下动脉。评估组织病理学上淋巴结转移的存在与全身PSMA-11 PET/CT（MRI）结果之间的区域和基于模板的相关性。我们还评估了PSMA-11 PET/CT（MRI）的诊断准确性与SLND发生时PSA水平的关系。结果患者发生SLND时的中位年龄为65岁（IQR为63 ~ 69岁），中位PSA水平为1.4ng/ml （IQR为0.8 ~ 2.9ng/ml）。SLND前，50例患者（77%）在RP后进行了额外治疗（26.2%为雄激素剥夺治疗，50.8%为放疗）。SLND切除淋巴结的中位数为40 (IQR 33-48)，阳性淋巴结的中位数为4 （IQR 2-6）。13.8%的淋巴结转移（2292例中有317例）。PSMA-11 PET/CT（MRI）阳性的淋巴结中位直径为7.2mm （IQR为5.3-9mm）。PSMA-11 PET阴性区域的转移性淋巴结中位直径为3.4mm （IQR为2.1-5.4mm）。在区域分析中，PSMA-11 PET/CT（MRI）的敏感性为72% ~ 100%，特异性为96% ~ 100%。区域特异性阳性预测值和阴性预测值分别为95% - 100%和93% - 100%。结论psma -11 PET/CT（MRI）对RP术后BCR患者淋巴结转移的鉴别有很好的效果。区域和分区域分析的高诊断准确性表明，这种方法有潜力实现区域定向治疗，而不是完全的双边治疗干预。PSMA-11 PET/CT（MRI）的表现取决于PSA水平和转移沉积物的大小。
PurposeTo assess the accuracy of [Ga-68]-PSMA-11 PET/CT or [Ga-68]-PSMA-11 PET/MRI (PSMA-11 PET/CT(MRI)) for lymph node (LN) staging using salvage LN dissection (SLND) in patients with biochemical recurrence (BCR) after radical prostatectomy (RP).Patients and methodsIn a prospective study, 65 consecutive patients who developed BCR after RP underwent SLND after PSMA-11 PET/CT(MRI) between 2014 and 2018. Extended SLND up to the inferior mesenteric artery was performed in all patients. Regional and template-based correlations between the presence of LN metastases on histopathology and whole-body PSMA-11 PET/CT(MRI) results were evaluated. The diagnostic accuracy of PSMA-11 PET/CT(MRI) was also evaluated in relation to PSA level at the time of SLND.ResultsThe median age of the patients at the time of SLND was 65years (IQR 63-69years) and the median PSA level was 1.4ng/ml (IQR 0.8-2.9ng/ml). Before SLND, 50 patients (77%) had additional therapy after RP (26.2% androgen-deprivation therapy and 50.8% radiotherapy). The median number of LNs removed on SLND was 40 (IQR 33-48) and the median number of positive nodes was 4 (IQR 2-6). LN metastases were seen in 13.8% of resected LNs (317 of 2,292). LNs positive on PSMA-11 PET/CT(MRI) had a median diameter of 7.2mm (IQR 5.3-9mm). Metastatic LNs in regions negative on PSMA-11 PET had a median diameter of 3.4mm (IQR 2.1-5.4mm). In a regional analysis, the sensitivity of PSMA-11 PET/CT(MRI) ranged from 72% to 100%, and the specificity from 96% to 100%. Region-specific positive and negative predictive values ranged from 95% to 100% and 93% to 100%, respectively.ConclusionPSMA-11 PET/CT(MRI) has a very good performance for the identification of LN metastases in patients with BCR after RP. The high diagnostic accuracy in the regional and subregional analyses demonstrates the potential of this approach to enable a region-directed instead of a complete bilateral therapeutic intervention. The performance of PSMA-11 PET/CT(MRI) is dependent on the PSA level and the size of the metastatic deposit.