Koehler Daniel, Sauer Markus, Klutmann Susanne, Apostolova Ivayla, Lehnert Wencke, Budäus Lars, Knipper Sophie, Maurer Tobias
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Nucl Med. 2023 Jan;64(1):59-62. doi: 10.2967/jnumed.122.263892. Epub 2022 Jul 14.
This case series evaluated the feasibility of prostate-specific membrane antigen (PSMA)-radioguided surgery (RGS) with Tc-MIP-1404 in recurrent prostate cancer. Nine patients with PSMA-positive lesions on PET/CT received Tc-MIP-1404 (median, 747 MBq; interquartile range [IQR], 710-764 MBq) 17.2 h (IQR, 16.9-17.5 h) before SPECT/CT and 22.3 h (IQR, 20.8-24.0 h) before RGS. Seventeen PSMA-positive lesions were detected on PET/CT (median short-axis diameter, 4 mm; IQR, 3-6 mm; median SUV, 8.9; IQR, 5.2-12.6). Nine of 17 (52.9%) were visible on SPECT/CT (median SUV, 13.8; IQR, 8.0-17.9). Except for 2 foci, all PET/CT-positive findings demonstrated intraoperative count rates above the background level (median count, 31; IQR, 17-89) and were lymph node metastases. Moreover, PSMA-RGS identified 2 additional metastases compared with PET/CT. Prostate-specific antigen values decreased after RGS in 6 of 9 patients (67%). PSMA-RGS with Tc-MIP-1404 identified lymph node metastases in all patients, including 2 additional lesions compared with PET/CT.
本病例系列评估了使用锝[Tc]MIP-1404进行前列腺特异性膜抗原（PSMA）放射性引导手术（RGS）在复发性前列腺癌中的可行性。9例在PET/CT上有PSMA阳性病变的患者在SPECT/CT前17.2小时（四分位间距[IQR]，16.9 - 17.5小时）和RGS前22.3小时（IQR，20.8 - 24.0小时）接受了锝[Tc]MIP-1404（中位数，747 MBq；IQR，710 - 764 MBq）。在PET/CT上检测到17个PSMA阳性病变（短轴直径中位数，4 mm；IQR，3 - 6 mm；SUV中位数，8.9；IQR，5.2 - 12.6）。17个病变中有9个（52.9%）在SPECT/CT上可见（SUV中位数，13.8；IQR，8.0 - 17.9）。除2个病灶外，所有PET/CT阳性发现的术中计数率均高于背景水平（计数中位数，31；IQR，17 - 89），且均为淋巴结转移。此外，与PET/CT相比，PSMA-RGS还发现了另外2处转移灶。9例患者中有6例（67%）在RGS后前列腺特异性抗原值下降。使用锝[Tc]MIP-1404的PSMA-RGS在所有患者中均发现了淋巴结转移，包括比PET/CT多发现的2个病灶。
