Department of Radiation Oncology, UH Leuven, Leuvens Kanker Instituut, Leuven, Belgium.
Eur Urol. 2011 Jul;60(1):125-30. doi: 10.1016/j.eururo.2011.01.015. Epub 2011 Jan 18.
Contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging for lymph node (LN) staging of prostate cancer (PCa) are largely inadequate.
Our aim was to assess prospectively the sensitivity, specificity, and positive and negative predictive values for the LN staging by (11)C-choline positron emission tomography (PET)-CT and MR diffusion-weighted imaging (DWI) of the pelvis before retropubic radical prostatectomy (RRP) with extended pelvic LN dissection (PLND).
DESIGN, SETTING, AND PARTICIPANTS: From February 2008 to August 2009, 36 patients with histologically proven PCa and no pelvic LN involvement on contrast-enhanced CT with a risk ≥ 10% but ≤ 35% at LN metastasis according to the Partin tables were enrolled in this study.
Patients preoperatively underwent (11)C-choline PET-CT and DWI. Subsequently all patients underwent a wide RRP and an extended PLND.
Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for LN status of (11)C-choline PET-CT and DWI were calculated with the final histopathology of the LNs as comparator.
Seventeen patients (47%) had a pN1 stage, and 38 positive LNs were identified. On a LN region-based analysis, sensitivity, specificity, PPV, NPV, and the number of correctly recognised cases at (11)C-choline PET-CT were 9.4%, 99.7%, 75.0%, 91.0%, and 7.9%, respectively, and at DWI these numbers were 18.8%, 97.6%, 46.2%, 91.7%, and 15.8%, respectively. Twelve LN regions containing macrometastases, of which 2 had capsular penetration, were not detected by (11)C-choline PET-CT; 11 LNs, of which 2 had capsular penetration, were not detected by DWI. This is a small study with 36 patients, but we intend to recruit more patients.
From this prospective histopathology-based evaluation of (11)C-choline PET-CT and DWI for LN staging in high-risk PCa patients, it is concluded that these techniques cannot be recommended at present to detect occult LN metastases before initial treatment.
前列腺癌（PCa）的淋巴结（LN）分期的对比增强计算机断层扫描（CT）和磁共振（MR）成像在很大程度上是不充分的。
我们的目的是前瞻性评估（11）C-胆碱正电子发射断层扫描（PET）-CT 和骨盆 MR 弥散加权成像（DWI）对经耻骨后根治性前列腺切除术（RRP）和广泛盆腔淋巴结清扫术（PLND）前 LN 分期的敏感性、特异性、阳性和阴性预测值。
设计、地点和参与者：从 2008 年 2 月至 2009 年 8 月，我们招募了 36 名经组织学证实的 PCa 患者，这些患者在增强 CT 上没有盆腔 LN 受累，根据 Partin 表，LN 转移的风险≥10%但≤35%。
患者术前接受（11）C-胆碱 PET-CT 和 DWI 检查。随后所有患者均接受广泛的 RRP 和广泛的 PLND。
以 LN 的最终组织病理学为对照，计算（11）C-胆碱 PET-CT 和 DWI 的 LN 状态的敏感性、特异性、阳性和阴性预测值（PPV 和 NPV）。
17 名患者（47%）处于 pN1 期，有 38 个阳性淋巴结。在 LN 区域基础分析中，（11）C-胆碱 PET-CT 的敏感性、特异性、PPV、NPV 和正确识别病例数分别为 9.4%、99.7%、75.0%、91.0%和 7.9%，DWI 的这些数字分别为 18.8%、97.6%、46.2%、91.7%和 15.8%。12 个包含大转移的 LN 区域，其中 2 个有包膜穿透，未被（11）C-胆碱 PET-CT 检测到；11 个 LN，其中 2 个有包膜穿透，未被 DWI 检测到。这是一项小型研究，共有 36 名患者，但我们打算招募更多的患者。
从这项对高危 PCa 患者进行的基于组织病理学的（11）C-胆碱 PET-CT 和 DWI 用于 LN 分期的前瞻性评估中可以得出结论，目前这些技术不能用于在初始治疗前检测隐匿性 LN 转移。
