Huang Shi-Ming, Yin Liang, Yue Jian-Lan, Li Yan-Feng, Yang Yang, Lin Zhi-Chun
Department of Nuclear Medicine, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Forces, Tianjin, China.
Medicine (Baltimore). 2018 Dec;97(50):e13344. doi: 10.1097/MD.0000000000013344.
Lymph node detection in prostate cancer is challenging and critical to determine treatment policy. Choline PET/CT (positron emission tomography/computed tomography) and magnetic resonance imaging (MRI) have been used for the evaluation of lymph node metastasis in patients with prostate cancer for the past decade. However, only limited patients underwent direct comparison studies.
To evaluate the diagnostic performance of choline PET/CT compared with MRI imaging for detecting lymph node metastases in prostate cancer patients.
Relevant English-language articles published before February 2018 were searched in PubMed database, Embase database, and Cochrane Library databases search using the keywords: (Prostate Neoplasm OR Prostate Cancer OR prostate carcinoma) and (Lymph Node) and (PET/CT OR positron emission tomography/computed tomography) and (choline or 2-hydroxy-N,N,N-trimethylethanaminium) and (magnetic resonance imaging OR MRI). Articles were included that directly compare the diagnostic performance and clinical utility of choline PET/CT and MRI for detecting lymph node metastases in prostate cancer patients. Study quality was assessed with QUADAS criteria. Analyses were performed on a per patient and a per node basis. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated using Meta-Disc 1.4 software. Summary receiver-operating characteristic (SROC) curves constructed.
A total of 362 patients from 8 studies involving fulfilled the inclusion criteria. On patient-based analysis, the pooled sensitivity, specificity, and DOR with a 95% confidence interval (CI) for choline PET/CT imaging were 0.59 (95%CI, 0.50-0.67), 0.92 (95%CI, 0.87-0.96), 17.37 (95%CI, 4.42-68.33), and for MRI imaging, they were 0.52 (95%CI, 0.44-0.61), 0.87 (95%CI, 0.81-0.92), 6.05 (95%CI, 3.09-11.85), respectively. On node-based, the corresponding values for choline PET/CT imaging were 0.51 (95%CI, 0.46-0.57), 0.99 (95%CI, 0.98-0.99), 65.55 (95%CI, 23.55-182.45), and for MRI imaging, they were 0.39 (95%CI, 0.34-0.44), 0.97 (95%CI, 0.96-0.97), 15.86 (95%CI, 8.96-28.05), respectively.
Choline PET/CT performed better than MRI imaging in evaluating the lymph nodes metastasis of prostate cancer patients and had the potential to be broadly applied in clinical practice.
前列腺癌中淋巴结检测具有挑战性，且对确定治疗策略至关重要。在过去十年中，胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）和磁共振成像（MRI）已用于评估前列腺癌患者的淋巴结转移情况。然而，仅有有限的患者接受了直接比较研究。
评估胆碱PET/CT与MRI成像在检测前列腺癌患者淋巴结转移方面的诊断性能。
在PubMed数据库、Embase数据库和Cochrane图书馆数据库中检索2018年2月之前发表的相关英文文章，使用的关键词为：（前列腺肿瘤或前列腺癌或前列腺癌）、（淋巴结）、（PET/CT或正电子发射断层扫描/计算机断层扫描）、（胆碱或2-羟基-N,N,N-三甲基乙铵）以及（磁共振成像或MRI）。纳入直接比较胆碱PET/CT和MRI在检测前列腺癌患者淋巴结转移方面的诊断性能和临床效用的文章。采用QUADAS标准评估研究质量。基于每位患者和每个淋巴结进行分析。使用Meta-Disc 1.4软件计算合并敏感性、特异性、诊断比值比（DOR）、阳性似然比（LR+）和阴性似然比（LR-）。构建汇总受试者工作特征（SROC）曲线。
来自8项研究的共362例患者符合纳入标准。基于患者的分析中，胆碱PET/CT成像的合并敏感性、特异性和95%置信区间（CI）的DOR分别为0.59（95%CI，0.50 - 0.67）、0.92（95%CI，0.87 - 0.96）、17.37（95%CI，4.42 - 68.33），而MRI成像的分别为0.52（95%CI，0.44 - 0.61）、0.87（95%CI，0.81 - 0.92）、6.05（95%CI，3.09 - 11.85）。基于淋巴结的分析中，胆碱PET/CT成像的相应值分别为0.51（95%CI，0.46 - 0.57）、0.99（95%CI，0.98 - 0.99）、65.55（95%CI，23.55 - 182.45），MRI成像的分别为0.39（95%CI，0.34 - 0.44）、0.97（95%CI，0.96 - 0.97）、15.86（95%CI，8.96 - 28.05）。
胆碱PET/CT在评估前列腺癌患者淋巴结转移方面比MRI成像表现更好，有在临床实践中广泛应用的潜力。
