双示踪剂 PET/CT 靶向、mpMRI 靶向、系统活检和联合活检在前列腺癌诊断中的应用：一项初步研究。
Dual-tracer PET/CT-targeted, mpMRI-targeted, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer: a pilot study.
机构信息
Department of Urology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China.
Department of PET Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China.
出版信息
Eur J Nucl Med Mol Imaging. 2022 Jul;49(8):2821-2832. doi: 10.1007/s00259-021-05636-1. Epub 2021 Dec 3.
PURPOSE
Growing evidence proved the efficacy of multi-parametric MRI (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)-guided targeted biopsy (TB) in prostate cancer (PCa) diagnosis, but there is no direct comparison between mpMRI-TB and PSMA PET/CT-TB. Gastrin-releasing peptide receptor (GRPR) is highly expressed in PCa, which can compensate for the unstable expression of PSMA in PCa. Therefore, we designed a study to compare the efficiency of mpMRI-TB, dual-tracer (GRPR and PSMA) PET/CT-TB, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer.
METHODS
One hundred twelve suspicious PCa patients were enrolled from September 2020 to June 2021. Patients with anyone of positive dual-tracer PET/CT or mpMRI underwent TB, and all enrolled patients underwent systematic biopsy (SB) after TB. The primary outcome was the detection rates of PCa in different biopsy strategies. Secondary outcomes were the performance of three imaging methods, omission diagnostic rates, and upgrading and downgrading of biopsy samples relative to those of prostatectomy specimens in different biopsy strategies. McNemar's tests and Bonferroni correction in multiple comparisons were used to compare the primary and secondary outcomes.
RESULTS
In 112 men, clinically significant PCa (grade group[GG] ≥ 2) accounted for 34.82% (39/112), and nonclinically significant PCa (GG = 1) accounted for 4.46% (5/112). Ga-PSMA PET/CT-TB achieved higher PCa detection rate (69.77%) and positive ratio of biopsy cores (0.44) compared with SB (39.29% and 0.12) and mpMRI-TB (36.14% and 0.23), respectively (P < 0.005). Dual-tracer PET/CT screen out patients for avoiding 52.67% (59/112) unnecessary biopsy, whereas dual-tracer PET/CT-TB plus SB achieved high detection rate (77.36%) without misdiagnosis of csPCa.
CONCLUSION
Dual-tracer PET/CT might screen patients for avoiding unnecessary biopsy. Dual-tracer PET/CT-TB plus SB might be a more effective and promising strategy for the definite diagnosis of clinically significant PCa than mpMRI-TB.
目的
越来越多的证据证明多参数 MRI（mpMRI）和前列腺特异性膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）引导的靶向活检（TB）在前列腺癌（PCa）诊断中的有效性，但 mpMRI-TB 和 PSMA PET/CT-TB 之间没有直接比较。胃泌素释放肽受体（GRPR）在 PCa 中高度表达，可弥补 PSMA 在 PCa 中的不稳定表达。因此，我们设计了一项研究，比较 mpMRI-TB、双示踪剂（GRPR 和 PSMA）PET/CT-TB、系统活检和联合活检在诊断前列腺癌中的效率。
方法
2020 年 9 月至 2021 年 6 月期间，共纳入 112 例可疑 PCa 患者。任何一种双示踪剂 PET/CT 或 mpMRI 阳性的患者均行 TB，所有入组患者 TB 后均行系统活检（SB）。主要结局是不同活检策略中 PCa 的检出率。次要结局是三种影像学方法的性能、漏诊率以及与前列腺切除术标本相比不同活检策略中活检样本的升级和降级。采用 McNemar 检验和多重比较中的 Bonferroni 校正比较主要和次要结局。
结果
在 112 名男性中，临床显著 PCa（GG≥2）占 34.82%（39/112），非临床显著 PCa（GG=1）占 4.46%（5/112）。Ga-PSMA PET/CT-TB 与 SB（39.29%和 0.12）和 mpMRI-TB（36.14%和 0.23）相比，PCa 检出率（69.77%）和活检阳性核数比（0.44）更高（P<0.005）。双示踪剂 PET/CT 可筛选出 52.67%（59/112）不必要的活检患者，而双示踪剂 PET/CT-TB 加 SB 则可实现高检出率（77.36%），而不会误诊 csPCa。
结论
双示踪剂 PET/CT 可能筛选出不需要活检的患者。与 mpMRI-TB 相比，双示踪剂 PET/CT-TB 加 SB 可能是一种更有效、更有前途的方法，可明确诊断临床显著 PCa。
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