Zanoni Lucia, Mei Riccardo, Bianchi Lorenzo, Giunchi Francesca, Maltoni Lorenzo, Pultrone Cristian Vincenzo, Nanni Cristina, Bossert Irene, Matti Antonella, Schiavina Riccardo, Fiorentino Michelangelo, Fonti Cristina, Lodi Filippo, D'Errico Antonietta, Brunocilla Eugenio, Fanti Stefano
Nuclear Medicine Unit, Istituto di Ricovero e Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy.
Cancers (Basel). 2021 Mar 29;13(7):1575. doi: 10.3390/cancers13071575.
The primary aim of the study was to evaluate the role of [F]Fluciclovine PET/CT in the characterization of intra-prostatic lesions in high-risk primary PCa patients eligible for radical prostatectomy, in comparison with conventional [C]Choline PET/CT and validated by prostatectomy pathologic examination. Secondary aims were to determine the performance of PET semi-quantitative parameters (SUVmax; target-to-background ratios [TBRs], using abdominal aorta, bone marrow and liver as backgrounds) for malignant lesion detection (and best cut-off values) and to search predictive factors of malignancy. A six sextants prostate template was created and used by PET readers and pathologists for data comparison and validation. PET visual and semi-quantitative analyses were performed: for instance, patient-based, blinded to histopathology; subsequently lesion-based, un-blinded, according to the pathology reference template. Among 19 patients included (mean age 63 years, 89% high and 11% very-high-risk, mean PSA 9.15 ng/mL), 45 malignant and 31 benign lesions were found and 19 healthy areas were selected ( 95). For both tracers, the location of the "blinded" prostate SUVmax matched with the lobe of the lesion with the highest pGS in 17/19 cases (89%). There was direct correlation between [F]Fluciclovine uptake values and pISUP. Overall, lesion-based ( 95), the performance of PET semiquantitative parameters, with either [F]Fluciclovine or [C]Choline, in detecting either malignant/ISUP2-5/ISUP4-5 PCa lesions, was moderate and similar (AUCs ≥ 0.70) but still inadequate (AUCs ≤ 0.81) as a standalone staging procedure. A [F]Fluciclovine TBR-L3 ≥ 1.5 would depict a clinical significant lesion with a sensitivity and specificity of 85% and 68% respectively; whereas a SUVmax cut-off value of 4 would be able to identify a ISUP 4-5 lesion in all cases (sensitivity 100%), although with low specificity (52%). TBRs (especially with threshold significantly higher than aorta and slightly higher than bone marrow), may be complementary to implement malignancy targeting.
本研究的主要目的是评估[F]氟西洛维PET/CT在适合根治性前列腺切除术的高危原发性前列腺癌患者前列腺内病变特征分析中的作用，与传统的[C]胆碱PET/CT进行比较，并通过前列腺切除术后病理检查进行验证。次要目的是确定PET半定量参数（SUVmax；以腹主动脉、骨髓和肝脏为背景的靶本比[TBRs]）在恶性病变检测中的性能（以及最佳临界值），并寻找恶性肿瘤的预测因素。创建了一个六分区前列腺模板，PET阅片者和病理学家使用该模板进行数据比较和验证。进行了PET视觉和半定量分析：例如，基于患者，对组织病理学结果不知情；随后基于病变，根据病理参考模板，不再设盲。纳入的19例患者（平均年龄63岁，89%为高危，11%为极高危，平均PSA 9.15 ng/mL）中，发现45个恶性病变和31个良性病变，并选取了19个健康区域（95）。对于两种示踪剂，在17/19例（89%）病例中，“不知情”的前列腺SUVmax位置与pGS最高的病变叶相匹配。[F]氟西洛维摄取值与pISUP之间存在直接相关性。总体而言，基于病变（95），[F]氟西洛维或[C]胆碱的PET半定量参数在检测恶性/ISUP2-5/ISUP4-5前列腺癌病变方面的性能中等且相似（AUC≥0.70），但作为独立的分期程序仍不充分（AUC≤0.81）。[F]氟西洛维TBR-L3≥1.5可描绘出具有临床意义的病变，敏感性和特异性分别为85%和68%；而SUVmax临界值为4能够在所有病例中识别ISUP 4-5病变（敏感性100%），尽管特异性较低（52%）。TBRs（特别是阈值显著高于主动脉且略高于骨髓）可能有助于实现对恶性肿瘤的靶向定位。
