Centro de Cirugía Robótica, Centro Médico A.B.C (American British Cowdray) Observatorio, Ciudad de México, México; Departamento de Urología, Hospital General de México, Universidad Nacional Autónoma de México, (UNAM), México.
Centro de Cirugía Robótica, Centro Médico A.B.C (American British Cowdray) Observatorio, Ciudad de México, México.
Urol Oncol. 2021 Aug;39(8):494.e1-494.e6. doi: 10.1016/j.urolonc.2020.10.074. Epub 2020 Nov 19.
This study aims to assess the diagnostic efficacy of Gallium-68-prostate-specific membrane antigen positron emission tomography (PET)/computed tomography (CT) (68Ga PSMA PET-CT) in primary nodal staging of high-risk prostate cancer (PCa) when compared to pathologic findings of extended pelvic lymph-node dissection (eLND).
The records of high-risk PCa patients who were preoperatively staged through 68Ga PSMA PET-CT and who underwent robot-assisted radical prostatectomy with eLND either alone or as part of multimodal definitive therapy between August 2016 and November 2019 were retrospectively reviewed. Surgeons were not blinded to the results of the 68Ga PSMA PET-CT scan. Pathologic uptake was defined as any anomalous uptake which was not better explained by another cause and was suggestive of PCa. The reference standard for this study was the pathologic confirmation using a node-based analysis. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for 68Ga PSMA PET-CT were calculated in a per-patient analysis using IBM SPSS Statistics version 25.
Seventeen patients met the selection criteria. Mean age was 63 years (range 44-77) and mean and median preoperative serum prostate specific antigen was 19.25 and 9 ng/ml (range 6-131), respectively. The most common pathologic Gleason score was 8 (52.9% of cases). Seven patients (41%) had positive surgical margins and were submitted to adjuvant radiotherapy. Mean number of per patient removed lymph-nodes was 13 (±2.19). 68Ga PSMA PET-CT showed findings compatible with lymph node metastases in 4/17 patients and with locally-confined disease in 13/17 patients. Following pathologic confirmation, the per-patient sensibility of the 68Ga PSMA PET-CT was calculated at 75% (1 false negative) and the specificity at 92.3% (1 false positive) for detection of lymph node metastasis on primary staging of high-risk PCa patients. Positive and negative predictive value were 75% and 92.3%, respectively; accuracy of the test was calculated at 88.2%. All patients were submitted to 68Ga PSMA PET-CT re-evaluation 6 months after surgery and tested negative for local, nodal, or distant recurrence of disease.
68Ga PSMA PET-CT appears to have a high negative predictive value for local lymph node metastases in high-risk primary PCa when compared to pathologic findings of eLND. Its role in the primary nodal staging of high-risk PCa patients worths further evaluation.
本研究旨在评估镓-68-前列腺特异性膜抗原正电子发射断层扫描（68Ga PSMA PET-CT）与扩大盆腔淋巴结清扫术（eLND）相比在高危前列腺癌（PCa）患者原发淋巴结分期中的诊断效能。
回顾性分析 2016 年 8 月至 2019 年 11 月期间，接受机器人辅助根治性前列腺切除术并接受 eLND 或作为多模态确定性治疗一部分的高危 PCa 患者的术前分期 68Ga PSMA PET-CT 检查记录。外科医生未对 68Ga PSMA PET-CT 扫描结果进行盲法评估。病理摄取定义为任何无法用其他原因更好解释且提示前列腺癌的异常摄取。本研究的参考标准是基于节点的分析的病理证实。使用 IBM SPSS Statistics 版本 25 在每位患者的分析中计算 68Ga PSMA PET-CT 的敏感性、特异性、阳性预测值、阴性预测值和准确性。
17 名患者符合选择标准。平均年龄为 63 岁（范围 44-77），平均和中位术前血清前列腺特异性抗原分别为 19.25 和 9 ng/ml（范围 6-131）。最常见的病理 Gleason 评分是 8（52.9%的病例）。7 名患者（41%）有阳性切缘，并接受辅助放疗。每位患者平均切除的淋巴结数为 13（±2.19）。68Ga PSMA PET-CT 在 17 名患者中的 4 名中显示与淋巴结转移相符的结果，在 13 名患者中显示局限性疾病。在病理证实后，68Ga PSMA PET-CT 在检测高危 PCa 患者原发分期中的淋巴结转移方面的每位患者的敏感性计算为 75%（1 例假阴性），特异性为 92.3%（1 例假阳性）。阳性和阴性预测值分别为 75%和 92.3%，检测的准确性计算为 88.2%。所有患者在手术后 6 个月接受 68Ga PSMA PET-CT 重新评估，结果均为阴性，无局部、淋巴结或远处疾病复发。
与 eLND 的病理结果相比，68Ga PSMA PET-CT 在高危原发性 PCa 中对局部淋巴结转移具有较高的阴性预测值。它在高危 PCa 患者的原发淋巴结分期中的作用值得进一步评估。
