Ga-PSMA PET/CT 对全切片检测前列腺癌中侵袭性筛状形态的诊断性能。
Diagnostic performance of Ga-PSMA PET/CT for identification of aggressive cribriform morphology in prostate cancer with whole-mount sections.
机构信息
Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology Nanjing University, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.
Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
出版信息
Eur J Nucl Med Mol Imaging. 2019 Jul;46(7):1531-1541. doi: 10.1007/s00259-019-04320-9. Epub 2019 Apr 25.
PURPOSE
To explore the diagnostic performance of Ga-PSMA PET/CT for identification of pathological cribriform morphology in prostate cancer (PCa).
METHODS
The study retrospectively enrolled 49 PCa patients who had undergone preoperative multiparametric MRI (mpMRI) and Ga-PSMA PET/CT, and who had Gleason pattern (GP) 4 and absence of GP 5 on radical prostatectomy specimens. Lesions with GP 4 were outlined and stratified according to their cribriform status. Volumes of interest were drawn on matched mpMRI and PET images, and parameters including average apparent diffusion coefficient (ADC), tenth percentile ADC (ADC) and maximum standardized uptake value (SUV) were derived. The Mann-Whitney U test was used for continuous variables and the chi-squared test for categorical variables. Receiver operating characteristic analysis was used to compare imaging parameters in identifying cribriform morphology. The associations between cribriform-positive PCa and imaging variables were evaluated in a univariate analysis using a logistic regression model.
RESULTS
A total of 62 lesions were identified in 49 patients with GP 4. Of these lesions, 37 (59.7%) in 34 patients (69.4%) showed cribriform morphology. ADC and ADC were similar between cribriform-positive and non-cribriform groups (P > 0.05), while SUV was significantly different (median SUV 18.3 vs. 9.4 per patient, P = 0.003, 18.2 vs. 7.2 per lesion, P < 0.001), yielding sensitivities and specificities of 76% and 86% in a per-patient analysis, and 77% and 88% in a per-lesion analysis, respectively. Further, PSMA was significantly overexpressed in cribriform-positive PCa (P = 0.003). SUV was a significant predictor of cribriform morphology in PCa (odds ratio 8.61, 95% confidence interval 4.96-25.27, per patient; odds ratio 11.93, 95% confidence interval 6.49-33.74, per lesion; both P < 0.001).
CONCLUSION
Ga-PSMA PET/CT effectively identifies the aggressive cribriform morphology in PCa.
目的
探讨 Ga-PSMA PET/CT 对前列腺癌（PCa）病理性筛状形态的诊断性能。
方法
本研究回顾性纳入了 49 例接受术前多参数 MRI（mpMRI）和 Ga-PSMA PET/CT 检查且前列腺切除标本中存在 Gleason 模式 4 且不存在 Gleason 模式 5 的 PCa 患者。根据筛状状态对具有 Gleason 模式 4 的病变进行轮廓勾画和分层。在匹配的 mpMRI 和 PET 图像上绘制感兴趣区，并得出平均表观扩散系数（ADC）、第 10 百分位数 ADC（ADC）和最大标准化摄取值（SUV）等参数。采用 Mann-Whitney U 检验比较连续变量，采用卡方检验比较分类变量。采用受试者工作特征分析比较影像学参数在识别筛状形态方面的能力。采用单变量分析中的逻辑回归模型评估与筛状阳性 PCa 相关的影像学变量之间的关系。
结果
在 49 例存在 Gleason 模式 4 的患者中，共确定了 62 个病变。其中，34 例（69.4%）患者的 37 个（59.7%）病变呈现筛状形态。在筛状阳性组和非筛状组之间，ADC 和 ADC 无显著差异（患者间 ADC 中位数分别为 1.03×10−3mm2/s 和 1.04×10−3mm2/s，P>0.05；病变间 ADC 中位数分别为 1.01×10−3mm2/s 和 1.02×10−3mm2/s，P>0.05），而 SUV 存在显著差异（患者间 SUV 中位数分别为 18.3 和 9.4 per patient，P=0.003；病变间 SUV 中位数分别为 18.2 和 7.2 per lesion，P<0.001），在患者水平的分析中，SUV 的敏感度和特异度分别为 76%和 86%，在病变水平的分析中，分别为 77%和 88%。进一步的研究发现，PSMA 在筛状阳性 PCa 中表达显著增加（P=0.003）。SUV 是 PCa 中筛状形态的显著预测因子（患者水平 OR 8.61，95%CI 4.96-25.27；病变水平 OR 11.93，95%CI 6.49-33.74；均 P<0.001）。
结论
Ga-PSMA PET/CT 可有效识别 PCa 中的侵袭性筛状形态。
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