Donswijk Maarten L, Ettema Rosemarijn H, Meijer Dennie, Wondergem Maurits, Cheung Zing, Bekers Elise M, van Leeuwen Pim J, van den Bergh Roderick C N, van der Poel Henk G, Vis André N, Oprea-Lager Daniela E
Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Department of Urology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Eur J Nucl Med Mol Imaging. 2024 May;51(6):1741-1752. doi: 10.1007/s00259-024-06594-0. Epub 2024 Jan 26.
Prostate-specific membrane antigen (PSMA) positron emission tomography/ computed tomography (PET/CT) is recognized as the most accurate imaging modality for detection of metastatic high-risk prostate cancer (PCa). Its role in the local staging of disease is yet unclear. We assessed the intra- and interobserver variability, as well as the diagnostic accuracy of the PSMA PET/CT based molecular imaging local tumour stage (miT-stage) for the local tumour stage assessment in a large, multicentre cohort of patients with intermediate and high-risk primary PCa, with the radical prostatectomy specimen (pT-stage) serving as the reference standard.
A total of 600 patients who underwent staging PSMA PET/CT before robot-assisted radical prostatectomy was studied. In 579 PSMA positive primary prostate tumours a comparison was made between miT-stage as assessed by four nuclear physicians and the pT-stage according to ISUP protocol. Sensitivity, specificity and diagnostic accuracy were determined. In a representative subset of 100 patients, the intra-and interobserver variability were assessed using Kappa-estimates.
The sensitivity and specificity of the PSMA PET/CT based miT-stage were 58% and 59% for pT3a-stage, 30% and 97% for ≥ pT3b-stage, and 68% and 61% for overall ≥ pT3-stage, respectively. No statistically significant differences in diagnostic accuracy were found between tracers. We found a substantial intra-observer agreement for PSMA PET/CT assessment of ≥ T3-stage (k 0.70) and ≥ T3b-stage (k 0.75), whereas the interobserver agreement for the assessment of ≥ T3-stage (k 0.47) and ≥ T3b-stage (k 0.41) were moderate.
In a large, multicentre study evaluating 600 patients with newly diagnosed intermediate and high-risk PCa, we showed that PSMA PET/CT may have a value in local tumour staging when pathological tumour stage in the radical prostatectomy specimen was used as the reference standard. The intra-observer and interobserver variability of assessment of tumour extent on PSMA PET/CT was moderate to substantial.
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）被认为是检测转移性高危前列腺癌（PCa）最准确的成像方式。其在疾病局部分期中的作用尚不清楚。我们评估了观察者内和观察者间的变异性，以及基于PSMA PET/CT的分子成像局部肿瘤分期（miT分期）在一大组多中心中高危原发性PCa患者局部肿瘤分期评估中的诊断准确性，以根治性前列腺切除术标本（pT分期）作为参考标准。
共研究了600例在机器人辅助根治性前列腺切除术前行分期PSMA PET/CT的患者。在579例PSMA阳性的原发性前列腺肿瘤中，比较了4名核医学医师评估的miT分期与根据国际泌尿病理学会（ISUP）协议确定的pT分期。确定了敏感性、特异性和诊断准确性。在100例患者的代表性子集中，使用Kappa估计值评估观察者内和观察者间的变异性。
基于PSMA PET/CT的miT分期对pT3a期的敏感性和特异性分别为58%和59%，对≥pT3b期分别为30%和97%，对总体≥pT3期分别为68%和61%。不同示踪剂之间在诊断准确性上未发现统计学显著差异。我们发现PSMA PET/CT评估≥T3期（κ=0.70）和≥T3b期（κ=0.75）时观察者内一致性较高，而评估≥T3期（κ=0.47）和≥T3b期（κ=0.41）时观察者间一致性为中等。
在一项评估600例新诊断的中高危PCa患者的大型多中心研究中，我们表明，以根治性前列腺切除术标本中的病理肿瘤分期作为参考标准时，PSMA PET/CT在局部肿瘤分期中可能具有价值。PSMA PET/CT上肿瘤范围评估的观察者内和观察者间变异性为中等至较高。
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