From the Departments of Radiology, Hematology/Oncology, Data Science, and Radiation Oncology, University of Mississippi Medical Center, Jackson.
South Med J. 2021 Nov;114(11):703-707. doi: 10.14423/SMJ.0000000000001314.
18F-fluciclovine (fluciclovine) is an amino acid analog approved by the Food and Drug Administration for use as a radiotracer in positron emission tomography (PET) in men with biochemical recurrence of suspected prostate cancer. The purpose of this study was to investigate the initial institutional experience with 18F-fluciclovine in the evaluation of prostate cancer with biochemical recurrence.
This study was a retrospective review of 135 patients who underwent 18F-fluciclovine PET-computed tomography (PET-CT) at a single institution from August 2018 through January 2020. Prognostic information, including prostate-specific level antigen (PSA) at the time of diagnosis, initial risk, initial Gleason score, and initial stage, was reviewed as well as the PSA level at the time of the scan. The images were reviewed by two radiologists with fellowship training in nuclear medicine and additional training to interpret the fluciclovine studies. A minority of studies were reviewed by a third fellowship-trained radiologist under the guidance of the two nuclear medicine-trained radiologists. In cases with abnormal radiopharmaceutical uptake in lymph nodes, the short-axis dimension of the lymph node or largest lymph node with abnormal uptake was noted. If CT or bone scan was performed within 4 months of the 18F-fluciclovine PET-CT, findings on the alternate imaging were compared with the results of the 18F-fluciclovine PET-CT.
Our institutional positivity rate was 75.6%, with 64 (67.4%) patients with metastatic disease and 71 (52.6%) patients with local recurrence detected by fluciclovine. As expected, the rate of positive examinations increased with increasing PSA values measured at the time of imaging ( < 0.001). Of the 54 patients with nodal disease, 35 had nonpathologically enlarged lymph nodes measuring <1 cm in maximum short-axis dimension. In more than half of the patients in this study, with conventional imaging, fluciclovine either discovered otherwise undetectable metastatic disease or suggested the presence of local recurrence.
Our single-institution experience with 18F-fluciclovine PET-CT has the largest number of patients to date in the literature and demonstrates the ability of fluciclovine to help guide clinical management in the detection of early recurrent disease.
18F-氟代赖氨酸（fluciclovine）是一种氨基酸类似物，已获得美国食品和药物管理局（FDA）批准，可作为正电子发射断层扫描（PET）中的示踪剂，用于疑似前列腺癌生化复发男性患者。本研究的目的是调查在生化复发前列腺癌评估中使用 18F-氟代赖氨酸的初始机构经验。
本研究是对 2018 年 8 月至 2020 年 1 月在一家机构接受 18F-氟代赖氨酸 PET-计算机断层扫描（PET-CT）的 135 例患者进行的回顾性研究。回顾了包括前列腺特异性抗原（PSA）在诊断时、初始风险、初始 Gleason 评分和初始分期在内的预后信息，以及扫描时的 PSA 水平。由两名核医学专业 fellowship培训并额外接受氟代赖氨酸研究解读培训的放射科医生对图像进行了回顾，少数研究由第三位核医学专业 fellowship培训的放射科医生在两位核医学专业放射科医生的指导下进行了回顾。如果在 18F-氟代赖氨酸 PET-CT 检查后 4 个月内进行了淋巴结闪烁扫描或骨扫描，将记录异常放射性药物摄取淋巴结的短轴尺寸或最大摄取淋巴结。如果 CT 或骨扫描在 18F-氟代赖氨酸 PET-CT 后 4 个月内进行，将比较替代成像的结果与 18F-氟代赖氨酸 PET-CT 的结果。
我们机构的阳性率为 75.6%，其中 64 例（67.4%）患者存在转移性疾病，71 例（52.6%）患者存在氟代赖氨酸检测到的局部复发。正如预期的那样，随着影像学检查时 PSA 值的升高，阳性检查的比例也随之增加（<0.001）。在 54 例有淋巴结疾病的患者中，有 35 例淋巴结无病理性肿大，最大短轴尺寸<1cm。在本研究的大多数患者中，氟代赖氨酸要么发现了其他无法检测到的转移性疾病，要么提示存在局部复发。
本机构使用 18F-氟代赖氨酸 PET-CT 的经验是迄今为止文献中患者数量最多的，证明了氟代赖氨酸在检测早期复发性疾病方面帮助指导临床管理的能力。
