Welch Brian T, Packard Ann T, Atwell Thomas D, Johnson Geoffrey B, Lowe Val J, Karnes Robert Jeffrey, Mynderse Lance A, Gunderson Tina M, Park Sean S, Stish Bradley J, Evans Jaden D, Kwon Eugene D, Davis Brian J, Nathan Mark A
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Department of Urology, Mayo Clinic, Rochester, Minnesota.
Adv Radiat Oncol. 2018 Sep 5;4(1):79-89. doi: 10.1016/j.adro.2018.08.022. eCollection 2019 Jan-Mar.
Management of recurrent prostate cancer necessitates timely diagnosis and accurate localization of the sites of recurrent disease. The purpose of this study was to assess predictors of histologic outcomes after 11C-choline positron emission tomography/computed tomography (CholPET) to increase the positive predictive value and specificity of CholPET in identifying imaging predictors of malignant and benign nodal disease to better inform clinical decision making regarding local therapy planning.
Retrospective review of patients undergoing CholPET followed by percutaneous core needle biopsy between January 1, 2010 and January 1, 2016. A total of 153 patients were identified who underwent 166 biopsy procedures. Patient, CholPET, procedural, and pathologic characteristics were recorded.
A total of 157 biopsies were technically successful, and 110 (70.1%; 95% confidence interval, 62.2-77.1) yielded histologic results abnormal for metastatic prostate cancer. Lesion location, lesion maximum standardized uptake value (SUVmax), SUV ratio (calculated as the ratio of SUVmax to SUV mean in the right atrium), prostate-specific antigen, lesion short axis length, total Gleason score, and castration resistance were all associated with abnormal biopsy results ( values <.001, <.001, <.001, .02, .02, .02, and .015, respectively). External iliac, common iliac, and inguinal sites were associated with much lower rates of histologic positivity (mean [95% confidence interval], 51.2% [35.1-67.1], 46.2% [19.2-74.9], and 33.3% [7.5-70.1]), respectively.
In a cohort of patients in whom core needle biopsy was performed after CholPET, characteristics of choline localization including node location, SUVmax, lesion-to-blood pool SUV ratio, prostate-specific antigen, total Gleason score, and castration resistance were significantly associated with abnormal biopsy results for metastatic disease on CholPET. Relatively high false positive rates were found in common iliac, external iliac, and inguinal lymph node locations. Histologic confirmation of these sites should be strongly considered in the appropriate clinical scenario before designing additional local therapy plans.
复发性前列腺癌的管理需要对复发疾病部位进行及时诊断和准确定位。本研究的目的是评估11C-胆碱正电子发射断层扫描/计算机断层扫描（CholPET）后组织学结果的预测因素，以提高CholPET在识别恶性和良性淋巴结疾病影像预测因素方面的阳性预测值和特异性，从而更好地为局部治疗计划的临床决策提供依据。
回顾性分析2010年1月1日至2016年1月1日期间接受CholPET检查并随后进行经皮芯针活检的患者。共确定了153例患者，他们接受了166次活检程序。记录患者、CholPET、程序和病理特征。
总共157次活检在技术上成功，其中110次（70.1%；95%置信区间，62.2 - 77.1）的组织学结果显示为转移性前列腺癌异常。病变位置、病变最大标准化摄取值（SUVmax）、SUV比值（计算为SUVmax与右心房SUV平均值之比）、前列腺特异性抗原、病变短轴长度、总 Gleason 评分和去势抵抗均与活检异常结果相关（P值分别 <.001、<.001、<.001、.02、.02、.02和.015）。髂外、髂总及腹股沟部位的组织学阳性率要低得多（平均值[95%置信区间]分别为51.2%[35.1 - 67.1]、46.2%[19.2 - 74.9]和33.3%[7.5 - 70.1]）。
在一组CholPET检查后进行芯针活检的患者中，胆碱定位特征，包括淋巴结位置、SUVmax、病变与血池SUV比值、前列腺特异性抗原、总Gleason评分和去势抵抗，与CholPET上转移性疾病的活检异常结果显著相关。在髂总、髂外和腹股沟淋巴结位置发现相对较高的假阳性率。在设计额外的局部治疗计划之前，在适当的临床情况下应强烈考虑对这些部位进行组织学确认。
