Malaspina Simona, Anttinen Mikael, Taimen Pekka, Jambor Ivan, Sandell Minna, Rinta-Kiikka Irina, Kajander Sami, Schildt Jukka, Saukko Ekaterina, Noponen Tommi, Saunavaara Jani, Dean Peter B, Sequeiros Roberto Blanco, Aronen Hannu J, Kemppainen Jukka, Seppänen Marko, Boström Peter J, Ettala Otto
Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
Department of Urology, University of Turku and Turku University Hospital, Turku, Finland.
Eur J Nucl Med Mol Imaging. 2021 Aug;48(9):2951-2959. doi: 10.1007/s00259-021-05296-1. Epub 2021 Mar 13.
To prospectively compare F-prostate-specific membrane antigen (PSMA)-1007 positron emission tomography (PET)/CT, whole-body magnetic resonance imaging (WBMRI) including diffusion-weighted imaging (DWI) and standard computed tomography (CT), in primary nodal staging of prostate cancer (PCa).
Men with newly diagnosed unfavourable intermediate- or high-risk PCa prospectively underwent F-PSMA-1007 PET/CT, WBMRI with DWI and contrast-enhanced CT within a median of 8 days. Six readers (two for each modality) independently reported pelvic lymph nodes as malignant, equivocal or benign while blinded to the other imaging modalities. Sensitivity, specificity and accuracy were reported according to optimistic (equivocal lesions interpreted as benign) and pessimistic (equivocal lesions interpreted as malignant) analyses. The reference standard diagnosis was based on multidisciplinary consensus meetings where available histopathology, clinical and follow-up data were used.
Seventy-nine patients completed all the imaging modalities, except for one case of interrupted WBMRI. Thirty-one (39%) patients had pelvic lymph node metastases, which were detected in 27/31 (87%), 14/31 (45%) and 8/31 (26%) patients by F-PSMA-1007 PET/CT, WBMRI with DWI and CT, respectively (optimistic analysis). In 8/31 (26%) patients, only F-PSMA-1007 PET/CT detected malignant lymph nodes, while the other two imaging modalities were reported as negative. At the patient level, sensitivity and specificity values for F-PSMA-1007 PET/CT, WBMRI with DWI and CT in optimistic analysis were 0.87 (95%CI 0.71-0.95) and 0.98 (95%CI 0.89-1.00), 0.37 (95%CI 0.22-0.55) and 0.98 (95%CI 0.89-1.00) and 0.26 (95%CI 0.14-0.43) and 1.00 (95%CI 0.93-1.00), respectively.
F-PSMA-1007 PET/CT showed significantly greater sensitivity in nodal staging of primary PCa than did WBMRI with DWI or CT, while maintaining high specificity.
Clinicaltrials.gov ID: NCT03537391.
前瞻性比较F-前列腺特异性膜抗原（PSMA）-1007正电子发射断层扫描（PET）/CT、包括扩散加权成像（DWI）的全身磁共振成像（WBMRI）和标准计算机断层扫描（CT）在前列腺癌（PCa）原发淋巴结分期中的应用。
新诊断为不良中危或高危PCa的男性患者在中位8天内前瞻性地接受了F-PSMA-1007 PET/CT、带DWI的WBMRI和增强CT检查。六位阅片者（每种检查方式两位）在对其他成像方式不知情的情况下，独立将盆腔淋巴结报告为恶性、可疑或良性。根据乐观分析（将可疑病变解释为良性）和悲观分析（将可疑病变解释为恶性）报告敏感性、特异性和准确性。参考标准诊断基于多学科共识会议，会上使用了可用的组织病理学、临床和随访数据。
79例患者完成了所有成像检查，除1例WBMRI检查中断。31例（39%）患者有盆腔淋巴结转移，F-PSMA-1007 PET/CT、带DWI的WBMRI和CT分别在27/31（87%）、14/31（45%）和8/31（26%）的患者中检测到转移（乐观分析）。在8/31（26%）的患者中，仅F-PSMA-1007 PET/CT检测到恶性淋巴结，而其他两种成像方式报告为阴性。在患者层面，乐观分析中F-PSMA-1007 PET/CT、带DWI的WBMRI和CT的敏感性和特异性值分别为0.87（95%CI 0.71 - 0.95）和0.98（95%CI 0.89 - 1.00）、0.37（95%CI 0.22 - 0.55）和0.98（95%CI 0.89 - 1.00）以及0.26（95%CI 0.14 - 0.43）和1.00（95%CI 0.93 - 1.00）。
F-PSMA-1007 PET/CT在原发性PCa的淋巴结分期中显示出比带DWI的WBMRI或CT显著更高的敏感性，同时保持高特异性。
Clinicaltrials.gov标识符：NCT03537391。
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