Nickols Nicholas, Anand Aseem, Johnsson Kerstin, Brynolfsson Johan, Borreli Pablo, Parikh Neil, Juarez Jesus, Jafari Lida, Eiber Mattias, Rettig Matthew
Radiation Oncology Service, VA Greater Los Angeles Healthcare System, Los Angeles, California.
Department of Radiation Oncology, David Geffen School of Medicine, UCLA, Los Angeles, California.
J Nucl Med. 2022 Feb;63(2):233-239. doi: 10.2967/jnumed.120.261863. Epub 2021 May 28.
Standardized staging and quantitative reporting are necessary to demonstrate the association of F-DCFPyL PET/CT imaging with clinical outcome. This work introduces an automated platform, aPROMISE, to implement and extend the Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) criteria. The objective is to validate the performance of aPROMISE in staging and quantifying disease burden in patients with prostate cancer who undergo prostate-specific antigen (PSMA) imaging. This was a retrospective analysis of 109 veterans with intermediate- or high-risk prostate cancer who underwent PSMA imaging. To validate the performance of aPROMISE, 2 independent nuclear medicine physicians conducted aPROMISE-assisted reads, resulting in standardized reports that quantify individual lesions and stage the patients. Patients were staged as having local disease only (miN0M0), regional lymph node disease only (miN1M0), metastatic disease only (miN0M1), or both regional and distant metastatic disease (miN1M1). The staging obtained from aPROMISE-assisted reads was compared with the staging by conventional imaging. Cohen pairwise κ-agreement was used to evaluate interreader variability. Correlation coefficients and intraclass correlation coefficients were used to evaluate the interreader variability of the quantitative assessment (molecular imaging PSMA [miPSMA] index) at each stage. Kendall tau and testing were used to evaluate the association of miPSMA index with prostate-specific antigen and Gleason score. All PSMA images of 109 veterans met the DICOM conformity and the requirements for the aPROMISE analysis. Both independent aPROMISE-assisted analyses demonstrated significant upstaging in patients with localized (23%, = 20/87) and regional (25%, = 2/8) tumor burden. However, a significant number of patients with bone metastases identified on conventional imaging (F-NaF PET/CT) were downstaged (29%, = 4/14). The comparison of the 2 independent aPROMISE-assisted reads demonstrated a high κ-agreement: 0.82 for miN0M0, 0.90 for miN1M0, and 0.77 for miN0M1. The Spearman correlation of quantitative miPSMA index was 0.93, 0.96, and 0.97, respectively. As a continuous variable, miPSMA index in the prostate was associated with risk groups defined by prostate-specific antigen and Gleason score. We demonstrated the consistency of the aPROMISE platform between readers and observed substantial upstaging in PSMA imaging compared with conventional imaging. aPROMISE may contribute to broader standardization of PSMA imaging assessment and to its clinical utility in the management of prostate cancer patients.
标准化分期和定量报告对于证明F-DCFPyL PET/CT成像与临床结果之间的关联是必要的。这项工作引入了一个自动化平台aPROMISE，以实施和扩展前列腺癌分子成像标准化评估（PROMISE）标准。目的是验证aPROMISE在对接受前列腺特异性抗原（PSMA）成像的前列腺癌患者进行分期和量化疾病负担方面的性能。这是一项对109名患有中高危前列腺癌且接受PSMA成像的退伍军人的回顾性分析。为了验证aPROMISE的性能，两名独立的核医学医生进行了aPROMISE辅助解读，生成了量化个体病变并对患者进行分期的标准化报告。患者被分期为仅患有局部疾病（miN0M0）、仅患有区域淋巴结疾病（miN1M0）、仅患有转移性疾病（miN0M1）或同时患有区域和远处转移性疾病（miN1M1）。将从aPROMISE辅助解读中获得的分期与传统成像的分期进行比较。使用Cohen配对κ一致性来评估阅片者间的变异性。使用相关系数和组内相关系数来评估各阶段定量评估（分子成像PSMA [miPSMA]指数）的阅片者间变异性。使用Kendall tau和检验来评估miPSMA指数与前列腺特异性抗原和Gleason评分之间的关联。109名退伍军人的所有PSMA图像均符合DICOM标准以及aPROMISE分析的要求。两项独立的aPROMISE辅助分析均显示，局部肿瘤负担患者（23%，= 20/87）和区域肿瘤负担患者（25%，= 2/8）的分期显著上调。然而，在传统成像（F-NaF PET/CT）上发现有骨转移的大量患者分期下调（29%，= 4/14）。两项独立的aPROMISE辅助解读的比较显示出较高的κ一致性：miN0M0为0.82，miN1M0为0.90，miN0M1为0.77。定量miPSMA指数的Spearman相关性分别为0.93、0.96和0.97。作为连续变量，前列腺中的miPSMA指数与由前列腺特异性抗原和Gleason评分定义的风险组相关。我们证明了aPROMISE平台在阅片者之间的一致性，并观察到与传统成像相比，PSMA成像中有大量分期上调的情况。aPROMISE可能有助于更广泛地标准化PSMA成像评估及其在前列腺癌患者管理中的临床应用。
