Fang Andrew M, Chapin Brian F, Shi Charles W, Sun Jia, Qayyum Aliya, Kundra Vikas, Corn Paul G, Kuban Deborah A, Ravizzini Gregory C, Surasi Devaki Shilpa S, Ma Jingfei, Bathala Tharakeswara K
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Prostate Cancer Prostatic Dis. 2024 Sep 17. doi: 10.1038/s41391-024-00893-1.
Staging patients with high-risk prostate cancer (HRPCa) with conventional imaging of computed tomography (CT) and bone scintigraphy (BS) is suboptimal. Therefore, we aimed to compare the accuracy of whole-body magnetic resonance imaging (WBMRI) with conventional imaging to stage patients with HRPCa.
We prospectively enrolled patients with newly diagnosed HRPCa (prostate-specific antigen ≥20 ng/ml and/or Grade Group ≥4). Patients underwent BS, CT of the abdomen and pelvis, and WBMRI within 30 days of evaluation. The primary endpoint was the diagnostic performances of detecting metastatic disease to the lymph nodes and bone for WBMRI and conventional imaging. The reference standard was defined by histopathology or by all available clinical information at 6 months of follow-up. To compare diagnostic tests, Exact McNemar's test and area under the curve (AUC) of the receiver operating characteristics curves were utilized.
Among 92 patients enrolled, 15 (16.3%) and 8 (8.7%) patients were found to have lymphatic and bone metastases, respectively. The sensitivity, specificity, and accuracy of WBMRI in detecting lymphatic metastases were 0.60 (95% confidence interval 0.32-0.84), 0.84 (0.74-0.92), and 0.80 (0.71-0.88), respectively, while CT were 0.20 (0.04-0.48), 0.92 (0.84-0.97), and 0.80 (0.71-0.88). The sensitivity, specificity, and accuracy of WBMRI to detect bone metastases were 0.25 (0.03-0.65), 0.94 (0.87-0.98), and 0.88 (0.80-0.94), respectively, while CT and BS were 0.12 (0-0.53), 0.94 (0.87-0.98), and 0.87 (0.78-0.93). For evaluating lymphatic metastases, WBMRI demonstrated a higher sensitivity (p = 0.031) and discrimination compared to CT (0.72 versus 0.56, p = 0.019).
For staging patients with HRPCa, WBMRI outperforms CT in the detection of lymphatic metastases and performs as well as CT and BS in the detection of bone metastases. Further studies are needed to assess the cost effectiveness of WBMRI and the utility of combined PSMA PET and WBMRI.
采用计算机断层扫描（CT）和骨闪烁显像（BS）等传统成像方法对高危前列腺癌（HRPCa）患者进行分期并不理想。因此，我们旨在比较全身磁共振成像（WBMRI）与传统成像对HRPCa患者进行分期的准确性。
我们前瞻性纳入新诊断的HRPCa患者（前列腺特异性抗原≥20 ng/ml和/或分级组≥4）。患者在评估的30天内接受了BS、腹部和盆腔CT以及WBMRI检查。主要终点是WBMRI和传统成像检测淋巴结和骨转移疾病的诊断性能。参考标准由组织病理学或随访6个月时所有可用的临床信息定义。为了比较诊断测试，使用了精确的McNemar检验和受试者操作特征曲线的曲线下面积（AUC）。
在纳入的92例患者中，分别有15例（16.3%）和8例（8.7%）患者发现有淋巴结和骨转移。WBMRI检测淋巴结转移的敏感性、特异性和准确性分别为0.60（95%置信区间0.32 - 0.84）、0.84（0.74 - 0.92）和0.80（0.71 - 0.88），而CT分别为0.20（0.04 - 0.48）、0.92（0.84 - 0.97）和0.80（0.71 - 0.88）。WBMRI检测骨转移的敏感性、特异性和准确性分别为0.25（0.03 - 0.65）、0.94（0.87 - 0.98）和0.88（0.80 - 0.94），而CT和BS分别为0.12（0 - 0.53）、0.94（0.87 - 0.98）和0.87（0.78 - 0.93）。对于评估淋巴结转移，与CT相比，WBMRI显示出更高的敏感性（p = 0.031）和鉴别能力（0.72对0.56，p = 0.019）。
对于HRPCa患者的分期，WBMRI在检测淋巴结转移方面优于CT，在检测骨转移方面与CT和BS表现相当。需要进一步研究来评估WBMRI的成本效益以及联合前列腺特异性膜抗原（PSMA）PET和WBMRI的效用。
