Initial Experience of 68Ga-PSMA PET/CT Imaging in High-risk Prostate Cancer Patients Prior to Radical Prostatectomy
Initial Experience of 68Ga-PSMA PET/CT Imaging in High-risk Prostate Cancer Patients Prior to Radical Prostatectomy
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DOI：
10.1016/j.eururo.2015.06.010
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发表时间：
2016-03-01
期刊：
影响因子：
23.4
通讯作者：
Rosenbaum, Clemens
中科院分区：
文献类型：
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作者：
Budaeus, Lars;Leyh-Bannurah, Sami-Ramzi;Rosenbaum, Clemens
前列腺特异性膜抗原（PSMA）的过度表达理论上使得利用镓 - 68（Ga - 68）标记的PSMA配体对前列腺癌（PCa）转移灶进行正电子发射断层扫描/计算机断层扫描（PET/CT）成像成为可能。在将这种方法用于复发性前列腺癌的功能成像时，已报道有较好的检测率；然而，到目前为止，Ga - 68 - PSMA PET/CT在术前识别淋巴结转移（LNMs）的诊断准确性尚未得到评估。我们回顾性地比较了术前Ga - 68 - PSMA PET/CT的淋巴结（LN）检查结果与前列腺根治术后的组织学检查结果。在前列腺根治术中，总共检测到608个淋巴结，其中包含53个淋巴结转移灶。30例患者中有12例（40%）存在淋巴结转移。Ga - 68 - PSMA PET/CT扫描确定4例患者（33.3%）为淋巴结真阳性，8例患者（66.7%）为假阴性。Ga - 68 - PSMA - PET/CT检测到的与未检测到的淋巴结转移灶的中位大小分别为13.6毫米和4.3毫米（p < 0.05）。Ga - 68 - PSMA PET/CT对淋巴结转移灶检测的总体敏感性、特异性、阳性预测值和阴性预测值分别为33.3%、100%、100%和69.2%。按侧分析显示相应的值分别为27.3%、100%、100%和52.9%。相反，Ga - 68 - PSMA PET/CT能够使前列腺内的肿瘤可视化。在92.9%的患者中，前列腺内的肿瘤病灶被正确预测。总体而言，Ga - 68 - PSMA PET/CT是一种有前景的功能成像工具；然而，我们的初步经验表明，淋巴结转移灶的大小对Ga - 68 - PSMA PET/CT的诊断准确性有重大影响。患者总结：我们评估了Ga - 68 - PSMA PET/CT在前列腺癌高危患者前列腺根治术前的诊断准确性。我们发现淋巴结转移灶的检测率受淋巴结转移灶大小的显著影响。（C）2015欧洲泌尿外科学会。由爱思唯尔出版集团出版。保留所有权利。
Prostate-specific membrane antigen (PSMA) overexpression theoretically enables targeting of prostate cancer (PCa) metastases using gallium Ga 68 (Ga-68)-labeled PSMA ligands for positron emission tomography/computed tomography (PET/CT) imaging. Promising detection rates have been reported when using this approach for functional imaging of recurrent PCa; however, until now, the diagnostic accuracy of Ga-68-PSMA PET/CT for preoperatively identifying lymph node metastases (LNMs) had not been assessed. We retrospectively compared preoperative Ga-68-PSMA PET/CT lymph node (LN) findings with histologic work-up after radical prostatectomy (RP). Overall, 608 LNs containing 53 LNMs were detected during RP. LNMs were present in 12 of 30 patients (40%). The Ga-68-PSMA PET/CT scans identified 4 patients (33.3%) as LN true positive and 8 patients (66.7%) as false negative. Median size of Ga-68-PSMA-PET/CT-detected versus undetected LNMs was 13.6 versus 4.3 mm (p < 0.05). Overall sensitivity, specificity, positive predictive value, and negative predictive value of Ga-68-PSMA PET/CT for LNM detection were 33.3%, 100%, 100%, and 69.2%, respectively. Per-side analyses revealed corresponding values of 27.3%, 100%, 100%, and 52.9%. Conversely, Ga-68-PSMA PET/CT enabled tumor visualization in the prostate. In 92.9% of patients, the intraprostatic tumor foci were correctly predicted. Overall, Ga-68-PSMA PET/CT is a promising tool for functional imaging; however, our initial experience revealed substantial influence of LNM size on the diagnostic accuracy of Ga-68-PSMA PET/CT.Patient summary: We assessed the diagnostic accuracy of Ga-68-PSMA PET/CT in high-risk prostate cancer patients prior to radical prostatectomy. We found that lymph node metastasis detection rates were substantially influenced by lymph node metastasis size. (C) 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.