Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA, 94305, USA.
Eur J Nucl Med Mol Imaging. 2023 Nov;50(13):4087-4095. doi: 10.1007/s00259-023-06385-z. Epub 2023 Aug 9.
There are image interpretation criteria to standardize reporting prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET). As up to 10% of prostate cancer (PC) do not express PSMA, other targets such as gastrin-releasing peptide receptor (GRPR) are evaluated. Research on GRPR-targeted imaging has been slowly increasing in usage at staging and biochemical recurrence (BCR) of PC. We therefore propose a modification of the Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) criteria (mPROMISE) for GRPR-targeted PET.
[ Ga]Ga-RM2 PET data from initially prospective studies performed at our institution were retrospectively reviewed: 44 patients were imaged for staging and 100 patients for BCR PC. Two nuclear medicine physicians independently evaluated PET according to the mPROMISE criteria. A third expert reader served as standard reference. Interreader reliability was computed for GRPR expression, prostate bed (T), lymph node (N), skeleton (Mb), organ (Mc) metastases, and final judgment of the scan.
The interrater reliability for GRPR PET at staging was moderate for GRPR expression (0.59; 95% confidence interval [CI] 0.40, 0.78), substantial for T-stage (0.78; 95% CI 0.63, 0.94), and almost perfect for N-stage (0.97; 95% CI 0.92, 1.00) and final judgment (0.92; 95% CI 0.82, 1.00). The interreader agreement at BCR showed substantial agreement for GRPR expression (0.70; 95% CI 0.59, 0.81) and final judgment (0.65; 95% CI 0.53, 0.78), while almost perfect agreement was seen across the major categories (T, N, Mb, Mc). Acceptable performance of the mPROMISE criteria was found for all subsets when compared to the standard reference.
Interpreting GRPR-targeted PET using the mPROMISE criteria showed its reliability with substantial or almost perfect interrater agreement across all major categories. The proposed modification of the PROMISE criteria will aid clinicians in decreasing the level of uncertainty, and clinical trials to achieve uniform evaluation, reporting, and comparability of GRPR-targeted PET.
Clinicaltrials.gov Identifier: NCT03113617 and NCT02624518.
为了规范前列腺特异性膜抗原（PSMA）靶向正电子发射断层扫描（PET）的报告，制定了影像学解释标准。由于多达 10%的前列腺癌（PC）不表达 PSMA，因此评估了其他靶标，如胃泌素释放肽受体（GRPR）。在 PC 的分期和生化复发（BCR）中，GRPR 靶向成像的研究使用逐渐增多。因此，我们提出了一种 GRPR 靶向 PET 的前列腺癌分子成像标准化评估（PROMISE）标准（mPROMISE）的修改版。
我们回顾性地分析了本机构进行的初步前瞻性研究中 [68Ga]Ga-RM2 PET 数据：44 例患者进行分期成像，100 例患者进行 BCR PC 成像。两位核医学医师根据 mPROMISE 标准独立评估 PET。第三位专家读者作为标准参考。计算了 GRPR 表达、前列腺床（T）、淋巴结（N）、骨骼（Mb）、器官（Mc）转移的读者间可靠性，以及扫描的最终判断。
分期时，GRPR PET 的两位读者间可靠性对于 GRPR 表达为中度（0.59；95%置信区间 [CI] 0.40，0.78），对于 T 期为显著（0.78；95%CI 0.63，0.94），对于 N 期和最终判断为近乎完美（0.97；95%CI 0.92，1.00）。BCR 时的两位读者间一致性对于 GRPR 表达和最终判断均为高度一致（0.70；95%CI 0.59，0.81），而主要类别（T、N、Mb、Mc）之间则为近乎完美的一致。与标准参考相比，所有亚组的 mPROMISE 标准都具有可接受的性能。
使用 mPROMISE 标准解释 GRPR 靶向 PET 显示，其在所有主要类别中均具有可靠的中度或近乎完美的读者间一致性。对 PROMISE 标准的修改将有助于临床医生降低不确定性水平，并使临床试验实现 GRPR 靶向 PET 的统一评估、报告和可比性。
Clinicaltrials.gov 标识符：NCT03113617 和 NCT02624518。
