Simsek Duygu Has, Sanli Yasemin, Kuyumcu Serkan, Engin Muge Nur, Buyukkaya Fikret, Demirci Emre
Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
J Nucl Med Technol. 2019 Sep;47(3):233-237. doi: 10.2967/jnmt.118.224303. Epub 2019 Apr 24.
Our purpose was to determine whether there is a clinical benefit to add lower-limb imaging in Ga-labeled prostate-specific membrane antigen (PSMA) PET/CT scans for patients with prostate cancer. In total, 701 patients with prostate cancer who underwent Ga-PSMA PET/CT were evaluated retrospectively. All patients underwent additional lower-limb imaging. Images were reanalyzed by experienced nuclear medicine physicians, and metastatic sites were documented. The prostate-specific antigen (PSA) level and Gleason score were also compared with Ga-PSMA PET/CT findings. In 601 patients (85.7%), at least 1 tumoral lesion was observed on Ga-PSMA PET/CT. The number of patients with bone metastasis in 2 forms was 278 patients (39.6%); 108 (15.4%) were oligometastatic (<4 metastases) and 170 (24.2%) were multimetastatic (≥4 metastases). In lower-limb imaging, bone metastasis was detected in 61 patients (8.7%), the specific locations of which were as follows: middle-distal femur ( = 54), tibia ( = 19), fibula ( = 24), and calcaneus ( = 1). Lower-limb metastasis was detected mostly in symptom-positive patients (70.1%) but in only 4% of the symptom-negative group. All patients with lower-extremity metastasis also had multiple bone metastases shown on limited whole-body Ga-PSMA PET/CT. The median PSA level was significantly higher in multimetastatic patients with lower-limb metastasis than in those without lower-limb metastasis ( < 0.001, Mann-Whitney test), but no statistical differences was found in terms of Gleason score (χ = 0.042, = 0.837). According to receiver-operating-characteristic analysis, PSA has a good predictive value for detecting lower-limb metastasis, with 76.6% sensitivity and 72% specificity (using a reference cutoff PSA level of 24 ng/mL [area under the curve, 0.81; 95% confidence interval, 0.74-0.87]). Lower-limb imaging did not change the metastatic status of disease or significantly affect the therapeutic approach. However, if multimetastatic patients present relevant symptoms for lower-limb metastasis, it could be beneficial to consider including lower-limb imaging for possible palliative therapies.
我们的目的是确定对于前列腺癌患者，在镓标记的前列腺特异性膜抗原（PSMA）PET/CT扫描中增加下肢成像是否具有临床益处。总共对701例接受镓-PSMA PET/CT检查的前列腺癌患者进行了回顾性评估。所有患者均接受了额外的下肢成像检查。由经验丰富的核医学医师对图像进行重新分析，并记录转移部位。还将前列腺特异性抗原（PSA）水平和 Gleason评分与镓-PSMA PET/CT检查结果进行了比较。在601例患者（85.7%）中，镓-PSMA PET/CT检查发现至少1个肿瘤病灶。两种形式的骨转移患者有278例（39.6%）；108例（15.4%）为寡转移（<4处转移），170例（24.2%）为多转移（≥4处转移）。在下肢成像检查中，61例患者（8.7%）检测到骨转移，其具体部位如下：股骨中下段（=54）、胫骨（=19）、腓骨（=24）和跟骨（=1）。下肢转移大多在有症状的患者中检测到（70.1%），而在无症状组中仅占4%。所有下肢转移患者在有限的全身镓-PSMA PET/CT检查中也显示有多处骨转移。多转移且有下肢转移的患者的PSA水平中位数显著高于无下肢转移的患者（<0.001，Mann-Whitney检验），但在Gleason评分方面未发现统计学差异（χ=0.042，=0.837）。根据受试者工作特征分析，PSA对检测下肢转移具有良好的预测价值，敏感性为76.6%，特异性为72%（使用参考临界PSA水平24 ng/mL[曲线下面积，0.81；95%置信区间，0.74 - 0.87]）。下肢成像未改变疾病的转移状态，也未显著影响治疗方法。然而，如果多转移患者出现下肢转移的相关症状，考虑进行下肢成像以进行可能的姑息治疗可能是有益的。
