[镓-68]PSMA-11 PET/CT 和多参数 MRI 用于逐层分析勾画大体肿瘤靶区，以全器官病理为参考标准 - 对原发性前列腺癌调强放疗计划的影响。

[Ga-]PSMA-11 PET/CT and multiparametric MRI for gross tumor volume delineation in a slice by slice analysis with whole mount histopathology as a reference standard - Implications for focal radiotherapy planning in primary prostate cancer.

机构信息

Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.

Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany.

出版信息

Radiother Oncol. 2019 Dec;141:214-219. doi: 10.1016/j.radonc.2019.07.005. Epub 2019 Aug 17.

DOI:10.1016/j.radonc.2019.07.005

PMID:31431366

Abstract

BACKGROUND AND PURPOSE

Focal therapies are a promising approach to treat prostate cancer (PCa) more precisely instead of conventional whole gland treatment. Nowadays, multiparametric MRI (mpMRI) is routinely used for gross tumor volume (GTV) delineation. The aim of our study was to compare PSMA-PET/CT and mpMRI for the delineation of intraprostatic tumor burden by using whole mount histopathology as a reference standard.

MATERIAL AND METHODS

17 prospectively enrolled patients with primary PCa underwent [Ga-]PSMA-11 PET/CT and mpMRI before radical prostatectomy. PSMA-PET/CT, mpMRI and histopathology of the resected specimens were co-registered. Two teams of experts generated GTV contours for mpMRI and PET, respectively. The imaging was validated on a lesion level and slice by slice in quadrants based on the distribution of PCa in histopathology. Overall, 772 quadrants were analyzed with 414 being true positive for tumor (53.6%).

RESULTS

Median tumor volumes were 10.4 ml for GTV-histo, 10.8 ml for PSMA-PET and 4.5 ml for mpMRI. Median tumor volume in mpMRI was significant (p < 0.05) smaller than GTV-PET and GTV-histo, respectively. The sensitivity and specificity were 86% and 87% for PSMA-PET, 58% and 94% for mpMRI and 91% and 84% for their GTV-union. In 133 quadrants PSMA-PET/CT correctly identified tumor where mpMRI found none. MpMRI identified 19 true positive quadrants exclusively.

CONCLUSION

Our investigation demonstrates an increased consensus of PSMA-PET with histopathology compared to mpMRI for intraprostatic GTV delineation, especially with a higher sensitivity. Additionally mpMRI contours underestimate tumor volume significantly. Thus PSMA-PET may be a complementary augmentation for GTV delineation in focal therapies.

摘要

背景与目的

局部治疗是一种有前途的方法，可以更精确地治疗前列腺癌（PCa），而不是传统的全腺治疗。如今，多参数 MRI（mpMRI）常规用于大体肿瘤体积（GTV）勾画。我们的研究旨在通过使用全器官病理作为参考标准，比较 PSMA-PET/CT 和 mpMRI 来勾画前列腺内肿瘤负担。

材料与方法

17 例原发性 PCa 患者在根治性前列腺切除术前接受[Ga-]PSMA-11 PET/CT 和 mpMRI 检查。PSMA-PET/CT、mpMRI 和切除标本的组织病理学进行了配准。两组专家分别为 mpMRI 和 PET 生成 GTV 轮廓。在基于组织病理学中 PCa 的分布的切片和象限的基础上，对成像进行了病变水平和切片水平的验证。总共分析了 772 个象限，其中 414 个象限为肿瘤阳性（53.6%）。

结果

GTV-histo 的中位肿瘤体积为 10.4ml，PSMA-PET 的中位肿瘤体积为 10.8ml，mpMRI 的中位肿瘤体积为 4.5ml。mpMRI 的肿瘤体积明显（p<0.05）小于 GTV-PET 和 GTV-histo。PSMA-PET 的灵敏度和特异性分别为 86%和 87%，mpMRI 的灵敏度和特异性分别为 58%和 94%，其 GTV 联合的灵敏度和特异性分别为 91%和 84%。在 133 个象限中，PSMA-PET/CT 正确识别了 mpMRI 未发现的肿瘤。mpMRI 单独识别了 19 个真正的阳性象限。