PSMA PET/CT在原发性前列腺癌局部分期中的准确性及观察者内和观察者间的变异性。

The accuracy and intra- and interobserver variability of PSMA PET/CT for the local staging of primary prostate cancer.

作者信息

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

机构信息

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.

出版信息

Eur J Nucl Med Mol Imaging. 2024 May;51(6):1741-1752. doi: 10.1007/s00259-024-06594-0. Epub 2024 Jan 26.

DOI:10.1007/s00259-024-06594-0

PMID:38273003

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11043118/

Abstract

PURPOSE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

摘要

目的

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。

方法

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。

结果

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。