评估生化复发前列腺癌：F-DCFPyL PET/CT 与多参数 MRI 的组织学验证比较。
Evaluating Biochemically Recurrent Prostate Cancer: Histologic Validation of F-DCFPyL PET/CT with Comparison to Multiparametric MRI.
机构信息
From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.).
出版信息
Radiology. 2020 Sep;296(3):564-572. doi: 10.1148/radiol.2020192018. Epub 2020 Jul 7.
Background Prostate cancer recurrence is found in up to 40% of men with prior definitive (total prostatectomy or whole-prostate radiation) treatment. Prostate-specific membrane antigen PET agents such as 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine 3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (F-DCFPyL) may improve detection of recurrence compared with multiparametric MRI; however, histopathologic validation is lacking. Purpose To determine the sensitivity, specificity, and positive predictive value (PPV) of F-DCFPyL PET/CT based on histologic analysis and to compare with pelvic multiparametric MRI in men with biochemically recurrent prostate cancer. Materials and Methods Men were prospectively recruited after prostatectomy and/or radiation therapy with rising prostate-specific antigen level (median, 2.27 ng/mL; range, 0.2-27.45 ng/mL) and a negative result at conventional imaging (bone scan and/or CT). Participants underwent F-DCFPyL PET/CT imaging and 3.0-T pelvic multiparametric MRI. Statistical analysis included Wald and modified χ tests. Results A total of 323 lesions were visualized in 77 men by using F-DCFPyL or multiparametric MRI, with imaging detection concordance of 25% (82 of 323) when including all lesions in the MRI field of view and 53% (52 of 99) when only assessing prostate bed lesions. F-DCFPyL depicted more pelvic lymph nodes than did MRI (128 vs 23 nodes). Histologic validation was obtained in 80 locations with sensitivity, specificity, and PPV of 69% (25 of 36; 95% confidence interval [CI]: 51%, 88%), 91% (40 of 44; 95% CI: 74%, 98%), and 86% (25 of 29; 95% CI: 73%, 97%) for F-DCFPyL and 69% (24 of 35; 95% CI: 50%, 86%), 74% (31 of 42; 95% CI: 42%, 89%), and 69% (24 of 35; 95% CI: 50%, 88%) for multiparametric MRI ( = .95, = .14, and = .07, respectively). In the prostate bed, sensitivity, specificity, and PPV were 57% (13 of 23; 95% CI: 32%, 81%), 86% (18 of 21; 95% CI: 73%, 100%), and 81% (13 of 16; 95% CI: 59%, 100%) for F-DCFPyL and 83% (19 of 23; 95% CI: 59%, 100%), 52% (11 of 21; 95% CI: 29%, 74%), and 66% (19 of 29; 95% CI: 44%, 86%) for multiparametric MRI ( = .19, = .02, and = .17, respectively). The addition of F-DCFPyL to multiparametric MRI improved PPV by 38% overall ( = .02) and by 30% ( = .09) in the prostate bed. Conclusion Findings with 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine 3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (F-DCFPyL) were histologically validated and demonstrated high specificity and positive predictive value. In the pelvis, F-DCFPyL depicted more lymph nodes and improved positive predictive value and specificity when added to multiparametric MRI. © RSNA, 2020 See also the editorial by Zukotynski and Rowe in this issue.
背景 前列腺癌复发在既往接受过明确治疗（全前列腺切除术或全前列腺放射治疗）的男性中高达 40%。前列腺特异性膜抗原 PET 示踪剂，如 2-(3-{1-羧基-5-[(6-[18F]氟吡啶 3-羰基)-氨基]-戊基}-脲基）-戊二酸（F-DCFPyL），与多参数 MRI 相比，可能提高复发的检出率；但是，尚缺乏组织病理学验证。目的 旨在通过组织学分析确定 F-DCFPyL PET/CT 的敏感性、特异性和阳性预测值（PPV），并与生化复发前列腺癌患者的盆腔多参数 MRI 进行比较。材料与方法 前瞻性纳入前列腺切除术和（或）放疗后前列腺特异性抗原水平升高（中位数为 2.27ng/mL；范围：0.2-27.45ng/mL）且常规影像学检查（骨扫描和/或 CT）结果阴性的男性患者。所有患者均行 F-DCFPyL PET/CT 成像和 3.0-T 多参数盆腔 MRI 检查。统计分析包括 Wald 和校正 χ2 检验。结果 77 例男性共显示 323 个病灶，当将 MRI 视野内的所有病灶包括在内时，F-DCFPyL 或多参数 MRI 的影像学检测一致性为 25%（82/323），当仅评估前列腺床病灶时为 53%（52/99）。F-DCFPyL 比 MRI 显示更多的盆腔淋巴结（128 个 vs 23 个淋巴结）。在 80 个部位获得组织学验证，F-DCFPyL 的敏感性、特异性和 PPV 分别为 69%（25/36；95%CI：51%，88%）、91%（40/44；95%CI：74%，98%）和 86%（25/29；95%CI：73%，97%），多参数 MRI 分别为 69%（24/35；95%CI：50%，86%）、74%（31/42；95%CI：42%，89%）和 69%（24/35；95%CI：50%，88%）（ =.95， =.14， =.07）。在前列腺床内，F-DCFPyL 的敏感性、特异性和 PPV 分别为 57%（23 个中的 13 个；95%CI：32%，81%）、86%（21 个中的 18 个；95%CI：73%，100%）和 81%（16 个中的 13 个；95%CI：59%，100%），多参数 MRI 分别为 83%（23 个中的 19 个；95%CI：59%，100%）、52%（21 个中的 11 个；95%CI：29%，74%）和 66%（29 个中的 19 个；95%CI：44%，86%）（ =.19， =.02， =.17）。与多参数 MRI 相比，F-DCFPyL 可总体提高 PPV 38%（ =.02），在前列腺床内提高 30%（ =.09）。结论 F-DCFPyL 的检测结果通过了组织学验证，表现出了高特异性和阳性预测值。在盆腔内，F-DCFPyL 比多参数 MRI 显示更多的淋巴结，并且可以提高阳性预测值和特异性。
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