Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
J Urol. 2014 Jul;192(1):103-10. doi: 10.1016/j.juro.2013.12.054. Epub 2014 Feb 8.
We evaluated the diagnostic accuracy of choline positron emission tomography/computerized tomography for nodal relapse of prostate cancer according to topographical site and tumor infiltration size in lymph nodes.
A total of 72 patients with nodal prostate cancer relapse after primary therapy underwent pelvic and/or retroperitoneal salvage lymph node dissection. Salvage was done after whole body positron emission tomography/computerized tomography with (11)C-choline or (18)F-fluoroethylcholine showed positron emission tomography positive lymph nodes but no other detectable metastasis. Diagnostic accuracy was evaluated in 160 dissected lymph node regions (pelvic left/right and retroperitoneal), 498 subregions (common, external and internal iliac, obturator, presacral, aortic bifurcation, aortal, vena caval and interaortocaval) and 2,122 lymph nodes.
Lymph node metastasis was present in 32% of resected lymph nodes (681 of 2,122), resulting in 238 positive subregions and 111 positive regions. Positron emission tomography/computerized tomography was positive for 110 regions and 209 subregions. Sensitivity, specificity, positive and negative predictive values, and accuracy were 91.9%, 83.7%, 92.7%, 82.0% and 89.4% (region based), 80.7%, 93.5%, 91.9%, 84.1% and 87.3% (subregion based), and 57.0%, 98.4%, 94.5%, 82.6% and 84.9% (lesion based), respectively. Of 393 positive lymph node metastases detected by this method 278 (70.7%) were in lymph nodes with a less than 10 mm short axis diameter. Imaging sensitivity was 13.3%, 57.4% and 82.8% for a tumor infiltration depth of 2 or greater to less than 3 mm, 5 or greater to less than 6 mm and 10 or greater to less than 11 mm, respectively. Lymph node metastasis site and the radiotracer ((11)C-choline/(18)F-fluoroethylcholine) had no substantial impact on diagnostic accuracy.
Choline positron emission tomography/computerized tomography detects affected lymph node regions (pelvic left/right and retroperitoneal) in patients with prostate cancer relapse with high accuracy and it seems helpful for guiding salvage lymph node dissection. Sensitivity decreases with the size of metastatic infiltration in lymph nodes. This technique detects metastasis in a significant fraction of lymph nodes that are not pathologically enlarged on computerized tomography.
我们根据肿瘤浸润淋巴结的位置和大小，评估胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）对前列腺癌淋巴结复发的诊断准确性。
72 例接受过原发治疗后出现淋巴结复发的前列腺癌患者，在全身 PET/CT 检查显示（11）C-胆碱或（18）F-氟乙基胆碱阳性淋巴结，但无其他可检测转移的情况下，进行了盆腔和/或腹膜后挽救性淋巴结切除术。在 160 个解剖的淋巴结区域（盆腔左/右侧和腹膜后）、498 个亚区（常见、外部和内部髂骨、闭孔、骶前、主动脉分叉、主动脉、腔静脉和主动脉-腔静脉之间）和 2122 个淋巴结中，评估了诊断准确性。
切除的淋巴结中存在淋巴结转移的占 32%（2122 个淋巴结中有 681 个），导致 238 个阳性亚区和 111 个阳性区域。PET/CT 检查有 110 个区域和 209 个亚区阳性。基于区域的敏感性、特异性、阳性和阴性预测值和准确性分别为 91.9%、83.7%、92.7%、82.0%和 89.4%（基于区域）、80.7%、93.5%、91.9%、84.1%和 87.3%（基于亚区）和 57.0%、98.4%、94.5%、82.6%和 84.9%（基于病变）。用这种方法检测到的 393 个阳性淋巴结转移中，278 个（70.7%）位于短轴直径小于 10 毫米的淋巴结中。肿瘤浸润深度为 2 毫米或以上至小于 3 毫米、5 毫米或以上至小于 6 毫米和 10 毫米或以上至小于 11 毫米时，成像敏感性分别为 13.3%、57.4%和 82.8%。淋巴结转移部位和放射性示踪剂（（11）C-胆碱/（18）F-氟乙基胆碱）对诊断准确性没有实质性影响。
胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）以较高的准确性检测出前列腺癌复发患者的受累淋巴结区域（盆腔左/右侧和腹膜后），似乎有助于指导挽救性淋巴结切除术。随着淋巴结内转移肿瘤浸润的大小，敏感性降低。该技术在计算机断层扫描未显示病理性增大的淋巴结中检测到了转移。
