[68Ga-]PSMA-11 PET/CT and multiparametric MRI for gross tumor volume delineation in a slice by slice analysis with whole mount histopathology as a reference standard - Implications for focal radiotherapy planning in primary prostate cancer
[68Ga-]PSMA-11 PET/CT and multiparametric MRI for gross tumor volume delineation in a slice by slice analysis with whole mount histopathology as a reference standard - Implications for focal radiotherapy planning in primary prostate cancer
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DOI：
10.1016/j.radonc.2019.07.005
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发表时间：
2019-12-01
影响因子：
5.7
通讯作者：
Grosu, Anca L.
中科院分区：
文献类型：
--
作者：
Bettermann, Alisa S.;Zamboglou, Constantinos;Grosu, Anca L.
背景和目的：局部治疗是一种很有前途的方法，可以更精确地治疗前列腺癌（PCa），而不是传统的全腺体治疗。如今，多参数MRI（mpMRI）常规用于大体肿瘤体积（GTV）勾画。我们的研究的目的是比较PSMA-PET/CT和mpMRI的划定前列腺内肿瘤负荷，通过使用整体安装组织病理学作为参考standard.Material和方法：17例前瞻性入组的原发性PCa患者进行[Ga-68-]PSMA-11 PET/CT和mpMRI根治性前列腺切除术前。对切除标本的PSMA-PET/CT、mpMRI和组织病理学进行联合登记。两个专家团队分别生成了mpMRI和PET的GTV轮廓。根据组织病理学中PCa的分布，在病变水平和象限中逐层验证成像。结果：GTV-histo、PSMA-PET和mpMRI的中位肿瘤体积分别为10.4 ml、10.8 ml和4.5 ml。mpMRI中的中位肿瘤体积分别显著（p < 0.05）小于GTV-PET和GTV-histo。PSMA-PET的敏感性和特异性分别为86%和87%，mpMRI的敏感性和特异性分别为58%和94%，而GTV-union的敏感性和特异性分别为91%和84%。在133个象限中，PSMA-PET/CT正确识别了mpMRI未发现的肿瘤。MpMRI确定了19个真正的阳性quadrants.Conclusion：我们的调查表明，增加的共识PSMA-PET与组织病理学相比，mpMRI前列腺内GTV划定，特别是具有较高的灵敏度。此外，mpMRI轮廓显着低估了肿瘤体积。因此，PSMA-PET可能是局部治疗中GTV描绘的补充增强。(C)2019 Elsevier B. V.版权所有。
Background and purpose: Focal therapies are a promising approach to treat prostate cancer (PCa) more precisely instead of conventional whole gland treatment. Nowadays, multiparametric MRI (mpMRI) is routinely used for gross tumor volume (GTV) delineation. The aim of our study was to compare PSMA-PET/CT and mpMRI for the delineation of intraprostatic tumor burden by using whole mount histopathology as a reference standard.Material and methods: 17 prospectively enrolled patients with primary PCa underwent [Ga-68-]PSMA-11 PET/CT and mpMRI before radical prostatectomy. PSMA-PET/CT, mpMRI and histopathology of the resected specimens were co-registered. Two teams of experts generated GTV contours for mpMRI and PET, respectively. The imaging was validated on a lesion level and slice by slice in quadrants based on the distribution of PCa in histopathology. Overall, 772 quadrants were analyzed with 414 being true positive for tumor (53.6%).Results: Median tumor volumes were 10.4 ml for GTV-histo, 10.8 ml for PSMA-PET and 4.5 ml for mpMRI. Median tumor volume in mpMRI was significant (p < 0.05) smaller than GTV-PET and GTV-histo, respectively. The sensitivity and specificity were 86% and 87% for PSMA-PET, 58% and 94% for mpMRI and 91% and 84% for their GTV-union. In 133 quadrants PSMA-PET/CT correctly identified tumor where mpMRI found none. MpMRI identified 19 true positive quadrants exclusively.Conclusion: Our investigation demonstrates an increased consensus of PSMA-PET with histopathology compared to mpMRI for intraprostatic GTV delineation, especially with a higher sensitivity. Additionally mpMRI contours underestimate tumor volume significantly. Thus PSMA-PET may be a complementary augmentation for GTV delineation in focal therapies. (C) 2019 Elsevier B.V. All rights reserved.