Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
J Nucl Med. 2020 Apr;61(4):540-545. doi: 10.2967/jnumed.119.232199. Epub 2019 Sep 27.
Our objective was to determine the diagnostic capabilities of combined prostate-specific membrane antigen (PSMA) PET/CT and sentinel node (SN) biopsy in PSMA PET/CT-negative patients for primary lymph node (LN) staging in prostate cancer (PCa) patients. Between January 2017 and March 2019, retrospectively, all consecutive patients with diagnosed intermediate- or high-risk primary PCa who underwent preoperative PSMA PET/CT (Ga or F-DCFPyL) followed by robot-assisted radical prostatectomy and extended pelvic LN dissection (ePLND) were included. All patients without suspected LN metastases on PSMA PET/CT were considered candidates for SN biopsy with indocyanine green-Tc-nanocolloid or Tc-nanocolloid with free indocyanine green used as tracers. The ePLND was used as a reference standard. Of 53 patients, 22 had positive PSMA PET/CT results and 31 underwent subsequent SN biopsy after negative PSMA PET/CT results. In total, 23 patients (43%) were pN1, of whom 6 (26%) had negative PSMA PET/CT results and underwent subsequent SN biopsy. The combined use of SN biopsy and PSMA PET/CT identified all pN1 patients (100% sensitivity; 95% confidence interval, 86%-100%) and performed correct nodal staging in 50 of 53 patients (94% diagnostic accuracy; 95% confidence interval, 84%-99%). SN biopsy identified significantly smaller LN metastases (median diameter, 2.0 mm; interquartile range, 1.0-3.8 mm) than PSMA PET/CT (median diameter, 5.5 mm; interquartile range, 2.6-9.3 mm; = 0.007). Combining both modalities led to a 94% accuracy for nodal staging in diagnosed intermediate- and high-risk primary PCa. Adding SN biopsy in patients with negative PSMA PET/CT results increased the combined sensitivity to 100% for detecting nodal metastases at ePLND. This diagnostic accuracy may provide valuable information for directing further treatment in PCa patients, such as the use of PSMA PET/CT and SN biopsy rather than ePLND as the preferred approach for staging before radiotherapy.
我们的目的是确定前列腺特异性膜抗原 (PSMA) PET/CT 联合前哨淋巴结 (SN) 活检在 PSMA PET/CT 阴性的前列腺癌 (PCa) 患者中进行原发淋巴结 (LN) 分期的诊断能力。2017 年 1 月至 2019 年 3 月，回顾性地纳入了所有接受过术前 PSMA PET/CT（Ga 或 F-DCFPyL）检查并随后接受机器人辅助根治性前列腺切除术和扩大骨盆 LN 清扫术 (ePLND) 的诊断为中高危原发性 PCa 的连续患者。所有 PSMA PET/CT 未见可疑 LN 转移的患者均被认为是使用吲哚菁绿-Tc-纳米胶体或 Tc-纳米胶体联合游离吲哚菁绿作为示踪剂进行 SN 活检的候选者。ePLND 被用作参考标准。53 例患者中，22 例 PSMA PET/CT 结果阳性，31 例 PSMA PET/CT 结果阴性后行 SN 活检。共有 23 例（43%）患者为 pN1，其中 6 例（26%）PSMA PET/CT 结果阴性，随后行 SN 活检。SN 活检和 PSMA PET/CT 的联合使用在所有 pN1 患者中均发现了（100%的敏感性；95%置信区间，86%-100%），并在 53 例患者中的 50 例中正确进行了淋巴结分期（94%的诊断准确性；95%置信区间，84%-99%）。SN 活检检测到的淋巴结转移明显小于 PSMA PET/CT（中位直径 2.0mm；四分位距 1.0-3.8mm）（中位直径 5.5mm；四分位距 2.6-9.3mm； = 0.007）。在诊断为中高危原发性 PCa 的患者中，联合使用这两种方法的淋巴结分期准确率达到 94%。在 PSMA PET/CT 结果阴性的患者中添加 SN 活检，将联合敏感性提高到 100%，用于检测 ePLND 时的淋巴结转移。这种诊断准确性可能为 PCa 患者提供有价值的信息，例如使用 PSMA PET/CT 和 SN 活检而不是 ePLND 作为放疗前首选分期方法。
