Wang Taisong, Zhao Lingzhou, Qiao Wenli, Sun Na, Zhao Jinhua, Xing Yan
Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Oncol. 2023 Jun 2;13:1165694. doi: 10.3389/fonc.2023.1165694. eCollection 2023.
Compared with PET/CT or PET/MRI, SPECT/CT is cheaper and more readily accessible. This study was designed to investigate the efficacy of Tc-HYNIC-PSMA SPECT/CT in detecting primary tumors and metastases in patients with newly diagnosed prostate cancer (PCa).
A retrospective analysis of 31 patients with pathologically proven PCa was performed at Shanghai General Hospital from November 2020 to November 2021. Planar whole-body imaging was performed on all patients with a SPECT/CT scan of PSMA-positive regions 3-4 h after intravenous injection of 740 MBq Tc-HYNIC-PSMA. Positive PSMA uptake lesions were evaluated, and SUVmean and SUVmax were measured in each lesion. Associations between SPECT/CT parameters and clinicopathologic factors (tPSA and Gleason Score) were analyzed. The diagnostic capability of SPECT/CT parameters, tPSA, and GS in distant metastatic detection was evaluated by logistic regression.
The SUVmean and SUVmax of the high-risk stratification subgroups (tPSA>20 ng/ml, GS ≥8, and tPSA >20 ng/ml and GS≥8) were higher than those of the low-moderate risk stratification subgroups, with sensitivities of 92% and 92%, respectively. Neither SPECT/CT parameters (SUVmean, SUVmax) nor clinicopathologic factors (tPSA, GS) had high sensitivity (80%, 90%, 80%, and 90%, respectively, P <0.05) in distant metastatic prediction. For both the guideline tPSA level (20 ng/ml) and the cut-off level (84.3 ng/ml), the difference in the distant metastasis detection rate between the low predicted tPSA group and the high predicted tPSA group was statistically significant (0% . 47.62%, = 0.005; 9.09% . 88.89%, = 0.000, respectively). Twenty patients with pathological 99mTc-PSMA avid only in the prostate beds underwent radical prostatectomy. Seven of them underwent lymph node dissection, a total of 35 lymph nodes were removed, and no lymph nodes were detected with metastasis, which was consistent with Tc-HYNIC-PSMA SPECT/CT.
Tc-HYNIC-PSMA SPECT/CT is effective in the risk stratification and distant metastasis detection of primary PCa patients. It is of great value in guiding treatment strategies.
与PET/CT或PET/MRI相比，SPECT/CT成本更低且更容易获得。本研究旨在探讨锝[Tc]甲氧异腈-前列腺特异性膜抗原（Tc-HYNIC-PSMA）SPECT/CT在检测新诊断前列腺癌（PCa）患者的原发肿瘤和转移灶方面的疗效。
对2020年11月至2021年11月在上海交通大学附属第一人民医院病理确诊为PCa的31例患者进行回顾性分析。所有患者在静脉注射740MBq Tc-HYNIC-PSMA后3-4小时进行PSMA阳性区域的SPECT/CT扫描及全身平面显像。对PSMA摄取阳性的病灶进行评估，并测量每个病灶的平均标准摄取值（SUVmean）和最大标准摄取值（SUVmax）。分析SPECT/CT参数与临床病理因素（总前列腺特异抗原[tPSA]和 Gleason评分）之间的相关性。通过逻辑回归评估SPECT/CT参数、tPSA和Gleason评分（GS）在远处转移检测中的诊断能力。
高危分层亚组（tPSA>20ng/ml、GS≥8以及tPSA>20ng/ml且GS≥8）的SUVmean和SUVmax高于低-中度风险分层亚组，敏感性分别为92%和92%。SPECT/CT参数（SUVmean、SUVmax）和临床病理因素（tPSA、GS）在远处转移预测中均未具有高敏感性（分别为80%、90%、80%和90%，P<0.05）。对于指南tPSA水平（20ng/ml）和临界值水平（84.3ng/ml），低预测tPSA组和高预测tPSA组在远处转移检测率上的差异具有统计学意义（分别为0%对47.62%，P=0.005；9.09%对88.89%，P=0.000）。20例病理检查显示仅前列腺床有99mTc-PSMA摄取的患者接受了根治性前列腺切除术。其中7例患者进行了淋巴结清扫，共切除35枚淋巴结，未检测到淋巴结转移，这与Tc-HYNIC-PSMA SPECT/CT检查结果一致。
Tc-HYNIC-PSMA SPECT/CT在原发性PCa患者的风险分层和远处转移检测中有效。对指导治疗策略具有重要价值。
