评估 F-PSMA-1007 PET/CT 在使用组织病理学作为标准的前列腺癌检测和识别中的价值。
Evaluating the value of F-PSMA-1007 PET/CT in the detection and identification of prostate cancer using histopathology as the standard.
机构信息
PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China.
出版信息
Cancer Imaging. 2023 Nov 3;23(1):108. doi: 10.1186/s40644-023-00627-x.
BACKGROUND
Prostate-specific membrane antigen (PSMA) PET/CT is a highly regarded radionuclide imaging modality for prostate cancer (PCa). This study aimed to evaluate the diagnostic performance of F-PSMA-1007 PET/CT in detecting intraprostatic lesions of PCa using radical prostatectomy (RP) specimens as a reference standard and to establish an optimal maximum standardized uptake value (SUVmax) cutoff for distinguishing between PCa and non-PCa lesions.
METHODS
We retrospectively collected 117 patients who underwent F-PSMA-1007 PET/CT before RP. The uptake of the index tumor and contralateral non-PCa lesion was assessed. Histopathology of RP specimens was used as the gold standard. Kappa test was used to evaluate the consistency of preoperative PSMA PET/CT staging and postoperative pathological staging. Finally, an SUVmax cutoff value was identified by receiver operating characteristic (ROC) curve analysis to distinguish PCa lesions from non-PCa lesions. A prospective cohort including 76 patients was used to validate the results.
RESULTS
The detection rate of F-PSMA-1007 PET/CT for prostate cancer was 96.6% (113/117). F-PSMA-1007 had a sensitivity of 91.2% and a positive predictive value (PPV) of 89.8% for the identification of intraprostatic lesions. The consistency test (Kappa = 0.305) indicated poor agreement between the pathologic T-stage and PSMA PET/CT T-stage. Based on ROC curve analysis, the appropriate SUVmax to diagnose PCa lesions was 8.3 (sensitivity of 71.3% and specificity 96.8%) with an area under the curve (AUC) of 0.93 (P < 0.001). This SUVmax cutoff discriminated PCa lesions from non-PCa lesions with a sensitivity of 74.4%, a specificity of 95.8% in the prospective validation group.
CONCLUSIONS
F-PSMA-1007 PET/CT demonstrated excellent performance in detecting PCa. An optimal SUVmax threshold (8.3) could be utilized to identify lesions of PCa by F-PSMA-1007 PET/CT.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04521894, Registered: August 17, 2020.
背景
前列腺特异性膜抗原（PSMA）PET/CT 是一种备受推崇的放射性核素成像方式，可用于前列腺癌（PCa）的诊断。本研究旨在评估 F-PSMA-1007 PET/CT 在使用根治性前列腺切除术（RP）标本作为参考标准检测前列腺内 PCa 病变方面的诊断性能，并建立最佳的最大标准化摄取值（SUVmax）截断值，以区分 PCa 与非 PCa 病变。
方法
我们回顾性收集了 117 例在 RP 前接受 F-PSMA-1007 PET/CT 的患者。评估了指数肿瘤和对侧非 PCa 病变的摄取情况。RP 标本的组织病理学检查作为金标准。采用 Kappa 检验评估术前 PSMA PET/CT 分期与术后病理分期的一致性。最后，通过受试者工作特征（ROC）曲线分析确定 SUVmax 截断值，以区分 PCa 病变与非 PCa 病变。一项包含 76 例患者的前瞻性队列研究用于验证结果。
结果
F-PSMA-1007 PET/CT 对前列腺癌的检出率为 96.6%（113/117）。F-PSMA-1007 对前列腺内病变的识别具有 91.2%的敏感性和 89.8%的阳性预测值（PPV）。一致性检验（Kappa=0.305）表明，病理 T 分期与 PSMA PET/CT T 分期之间的一致性较差。基于 ROC 曲线分析，诊断 PCa 病变的合适 SUVmax 为 8.3（敏感性为 71.3%，特异性为 96.8%），曲线下面积（AUC）为 0.93（P<0.001）。这一 SUVmax 截断值在前瞻性验证组中，区分 PCa 病变与非 PCa 病变的敏感性为 74.4%，特异性为 95.8%。
结论
F-PSMA-1007 PET/CT 在检测 PCa 方面表现出色。通过 F-PSMA-1007 PET/CT，最佳 SUVmax 阈值（8.3）可用于识别 PCa 病变。
试验注册
ClinicalTrials.gov 标识符：NCT04521894，注册日期：2020 年 8 月 17 日。
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