Rhee Handoo, Blazak John, Tham Chui Ming, Ng Keng Lim, Shepherd Benjamin, Lawson Malcolm, Preston John, Vela Ian, Thomas Paul, Wood Simon
Department of Urology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia.
University of Queensland, School of Medicine, Brisbane, Australia.
EJNMMI Res. 2016 Dec;6(1):76. doi: 10.1186/s13550-016-0231-6. Epub 2016 Oct 22.
In this study, we prospectively evaluate the diagnostic potential of a gallium-68 (68Ga) prostate-specific membrane antigen (PSMA)-binding ligand and positron emission tomography (PET) in detecting metastatic lesions in patients with renal tumour. The secondary aim was to determine whether the findings would result in the alteration of patient management.
Ten patients with renal lesion and potential metastatic disease on conventional imaging were recruited. Patients underwent PSMA PET in addition to standard imaging. Nine patients underwent nephrectomy and 4 patients underwent additional targeted biopsy to provide specimens for histopathological validation. There were 89 pathological lesions on CT, of which 32 were removed or biopsied for histopathological correlation. With PSMA PET, 86 PET avid lesions were identified with 36 samples being available for analysis. Thirty-five of 36 samples were positive for renal cell carcinoma deposits, whilst 1 sample was inconclusive for diagnosis on biopsy. For the histologically confirmed lesions, there were no false-negative PSMA PET lesions; however, CT was false negative in 11. In two patients, surgical strategies were changed based on PSMA PET findings.
PSMA PET may potentially have a role in the preoperative staging of advanced renal cell carcinoma as PET detected multiple histologically proven metastatic lesions which were false negative on CT scanning, resulting in change in surgical strategies in some patients. We cautiously support a larger study to confirm these results and to assess the longitudinal impact on patient outcomes.
Australia and New Zealand Clinical Trial Registry (ANZCTR), ACTRN12615000854538 .
在本研究中，我们前瞻性评估了镓-68（68Ga）前列腺特异性膜抗原（PSMA）结合配体和正电子发射断层扫描（PET）在检测肾肿瘤患者转移灶方面的诊断潜力。次要目的是确定这些发现是否会导致患者治疗方案的改变。
招募了10例经传统影像学检查发现有肾脏病变且可能存在转移疾病的患者。患者除接受标准影像学检查外，还接受了PSMA PET检查。9例患者接受了肾切除术，4例患者接受了额外的靶向活检以提供组织病理学验证的标本。CT检查发现89个病理病变，其中32个被切除或活检以进行组织病理学相关性分析。通过PSMA PET，共识别出86个PET摄取阳性病变，其中36个样本可供分析。36个样本中有35个肾细胞癌沉积物呈阳性，而1个样本活检诊断结果不明确。对于经组织学证实的病变，PSMA PET没有假阴性病变；然而，CT有11例假阴性。在两名患者中，手术策略根据PSMA PET结果进行了改变。
PSMA PET可能在晚期肾细胞癌的术前分期中发挥作用，因为PET检测到多个经组织学证实的转移病变，而这些病变在CT扫描中为假阴性，导致部分患者的手术策略发生改变。我们谨慎支持开展更大规模的研究以证实这些结果，并评估其对患者预后的长期影响。
澳大利亚和新西兰临床试验注册中心（ANZCTR），ACTRN12615000854538 。
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