Ponsky L E, Cherullo E E, Starkey R, Nelson D, Neumann Donald, Zippe C D
Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Prostate Cancer Prostatic Dis. 2002;5(2):132-5. doi: 10.1038/sj.pcan.4500570.
Diagnostic methods are limited for detecting microscopic soft tissue metastases in patients with prostate cancer. Previous studies using (111)Indium Capromab Pendetide (ProstaScint scan) analyzed patients with extensive localized tumor (prostate specific antigen (PSA) >20 ng/ml) not optimal for surgical therapy. We evaluated the role of the ProstaScint trade mark scan in a preoperative population to provide histological documentation and to assess its utility in a surgical population. A total of 22 preoperative patients, underwent a ProstaScint scan. The mean preoperative PSA was 16.0 ng/ml (range 3.9-33 ng/ml). The mean Gleason score at biopsy was 6.9 (range 6-9). Each patient underwent a radical retropubic prostatectomy and bilateral pelvic lymph node dissection, which included resection of both obturator and common iliac lymph nodes. Histologic analysis of the resected lymph nodes provided the standard of comparison with the ProstaScint scan. The results of the scan and pathology for all 22 patients were compared with the bilateral obturator and iliac nodes, creating 88 data points. Nine areas (10%) were positive on the scan. One of these (11%) was a true positive while the other eight (89%) were false positives. Seventy-nine areas (90%) were negative on scan results. Of these, five areas (6%) were false negatives and 74 areas (94%) were true negatives. The scan yielded a sensitivity of 17%, specificity of 90%, negative predictive value (NPV) of 94% and a positive predictive value (PPV) of 11%. The high false positive rate and low PPV of ProstaScint scans overestimates metastatic lymph nodes disease, and is not useful when used preoperatively.
诊断方法在检测前列腺癌患者的微观软组织转移方面存在局限性。先前使用（111）铟卡妥莫单抗（ProstaScint扫描）的研究分析了广泛局部肿瘤（前列腺特异性抗原（PSA）>20 ng/ml）且不适合手术治疗的患者。我们评估了ProstaScint商标扫描在术前人群中的作用，以提供组织学记录并评估其在手术人群中的效用。共有22例术前患者接受了ProstaScint扫描。术前PSA的平均值为16.0 ng/ml（范围3.9 - 33 ng/ml）。活检时Gleason评分的平均值为6.9（范围6 - 9）。每位患者均接受了耻骨后根治性前列腺切除术和双侧盆腔淋巴结清扫术，其中包括切除闭孔和髂总淋巴结。对切除淋巴结的组织学分析提供了与ProstaScint扫描进行比较的标准。将所有22例患者的扫描结果和病理结果与双侧闭孔和髂淋巴结进行比较，产生了88个数据点。扫描结果中有9个区域（10%）呈阳性。其中1个区域（11%）为真阳性，另外8个区域（89%）为假阳性。扫描结果中有79个区域（90%）呈阴性。其中，5个区域（6%）为假阴性，74个区域（94%）为真阴性。该扫描的敏感性为17%，特异性为90%，阴性预测值（NPV）为94%，阳性预测值（PPV）为11%。ProstaScint扫描的高假阳性率和低PPV高估了转移性淋巴结疾病，术前使用时并无用处。
