Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, The Netherlands.
Department of Urology, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands.
J Urol. 2020 Mar;203(3):537-545. doi: 10.1097/JU.0000000000000531. Epub 2019 Sep 6.
Prospective validation of Ga prostate specific membrane antigen positron emission tomography/computerized tomography is lacking in initial staging of prostate cancer. In this study we evaluated the diagnostic accuracy of Ga prostate specific membrane antigen positron emission tomography/computerized tomography for detecting lymph node metastasis in patients with intermediate-high risk prostate cancer.
Patients with newly diagnosed prostate cancer and negative bone scan findings at greater than 10% MSKCC (Memorial Sloan Kettering Cancer Center) risk for lymph node metastasis were prospectively included in study from October 2017 to October 2018. In candidates for extended pelvic lymph node dissection Ga prostate specific membrane antigen positron emission tomography/computerized tomography was performed prior to planned surgery. Scan results were evaluated in a second tumor board meeting to assess a potential change of management. Sensitivity, specificity, and positive and negative predictive value for detecting lymph node metastasis were calculated per patient and per resection template using histopathology as the reference. A positron emission tomography based change of management was also reported.
A total of 103 patients were eligible for analysis and 97 extended pelvic lymph node dissections were performed. In 41 patients (42.3%) there was a total of 85 lymph node metastases. Positron emission tomography was positive in 17 patients, resulting in 41.5% patient based sensitivity (95% CI 26.7-57.8) for detecting lymph node metastasis. The patient based specificity rate was 90.9% (95% CI 79.3-96.6), and positive and negative predictive values were 77.3% (95% CI 54.2-91.3) and 67.6% (95% CI 55.6-77.7), respectively. A positron emission tomography based change of treatment was observed in 13 patients (12.6%).
In patients with newly diagnosed prostate cancer at greater than 10% MSKCC risk for lymph node involvement Ga prostate specific membrane antigen positron emission tomography/computerized tomography detected lymph node metastasis with high specificity and moderate sensitivity. This led to a treatment change in 12.6% of patients.
Ga 前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描在前列腺癌的初始分期中缺乏前瞻性验证。在这项研究中，我们评估了 Ga 前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描对中高危前列腺癌患者检测淋巴结转移的诊断准确性。
从 2017 年 10 月至 2018 年 10 月，前瞻性地纳入了新诊断为前列腺癌且骨扫描结果为大于 10%MSKCC（纪念斯隆凯特琳癌症中心）淋巴结转移风险的患者。对于拟行扩大盆腔淋巴结清扫术的患者，在计划手术前进行 Ga 前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描。在第二次肿瘤委员会会议上评估扫描结果，以评估管理策略的潜在变化。根据组织病理学作为参考，计算每位患者和每个切除模板的检测淋巴结转移的敏感性、特异性、阳性预测值和阴性预测值。还报告了基于正电子发射断层扫描的治疗策略变化。
共有 103 例患者符合分析条件，97 例接受了扩大盆腔淋巴结清扫术。在 41 例（42.3%）患者中，共发现 85 个淋巴结转移。17 例患者的正电子发射断层扫描呈阳性，导致检测淋巴结转移的患者基础敏感性为 41.5%（95%CI26.7-57.8）。患者基础特异性率为 90.9%（95%CI79.3-96.6），阳性和阴性预测值分别为 77.3%（95%CI54.2-91.3）和 67.6%（95%CI55.6-77.7）。13 例（12.6%）患者出现基于正电子发射断层扫描的治疗策略改变。
在大于 10%MSKCC 淋巴结受累风险的新诊断前列腺癌患者中，Ga 前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描检测淋巴结转移具有较高的特异性和中等敏感性。这导致 12.6%的患者治疗策略发生改变。
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