Vazquez Gonzalez Jose R, Vasquez Lastra Carlos M, Villeda Sandoval Christian I, Martinez Torres Brandon, Santacruz Chavez Francisco A
Urology, Centro Medico ABC, Mexico City, MEX.
Urologic Oncology, Centro Medico ABC, Mexico City, MEX.
Cureus. 2025 Apr 10;17(4):e82019. doi: 10.7759/cureus.82019. eCollection 2025 Apr.
Positron emission tomography-computed tomography with prostate-specific membrane antigen (PET-CT PSMA) has revolutionized the preoperative staging of prostate cancer, particularly for assessing seminal vesicle and lymph node invasion. However, its correlation and agreement with definitive histopathology remain unclear.
The study aimed to evaluate the diagnostic performance, correlation, and agreement between PET-CT PSMA and final histopathological findings for seminal vesicle and lymph node invasion in patients undergoing robot-assisted radical prostatectomy.
This retrospective, single-center study included 194 patients who underwent PET-CT PSMA and radical prostatectomy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Correlation (Spearman's rho) and agreement (kappa coefficient) between PET-CT PSMA and final histopathology were analyzed.
Seminal vesicle invasion was detected in 11.9% of cases by histopathology and 12.4% by PET-CT PSMA, while lymph node invasion was reported in 4.8% and 10.3%, respectively. PET-CT PSMA exhibited high specificity (91.23% for seminal vesicles, 92% for lymph nodes) and high NPVs (91.76% and 96.84%, respectively), but low sensitivity (39.13% and 40%) and low PPV for lymph nodes (20%). Correlation between PET-CT PSMA and histopathology was low for seminal vesicle invasion (rho = 0.298; p = 0.0001) and lymph node invasion (rho = 0.232; p = 0.017). Agreement was also poor for seminal vesicle invasion (kappa = 0.298) and lymph node invasion (kappa = 0.217).
PET-CT PSMA demonstrates high specificity and NPV but low sensitivity, correlation, and agreement with final histopathology. While useful for ruling out disease, its positive findings should be interpreted with caution.
正电子发射断层扫描-计算机断层扫描结合前列腺特异性膜抗原（PET-CT PSMA）彻底改变了前列腺癌的术前分期，尤其是在评估精囊和淋巴结侵犯方面。然而，其与最终组织病理学的相关性和一致性仍不明确。
本研究旨在评估接受机器人辅助根治性前列腺切除术患者的PET-CT PSMA与精囊和淋巴结侵犯的最终组织病理学结果之间的诊断性能、相关性和一致性。
这项回顾性单中心研究纳入了194例行PET-CT PSMA检查及根治性前列腺切除术的患者。计算了敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和总体准确率。分析了PET-CT PSMA与最终组织病理学之间的相关性（Spearman秩相关系数）和一致性（kappa系数）。
组织病理学检测到11.9%的病例存在精囊侵犯，PET-CT PSMA检测到12.4%；而淋巴结侵犯分别为4.8%和10.3%。PET-CT PSMA显示出高特异性（精囊为91.23%，淋巴结为92%）和高NPV（分别为91.76%和96.84%），但敏感性低（分别为39.13%和40%），淋巴结的PPV低（20%）。PET-CT PSMA与组织病理学在精囊侵犯方面的相关性较低（rho = 0.298；p = 0.0001），在淋巴结侵犯方面也较低（rho = 0.232；p = 0.017）。精囊侵犯和淋巴结侵犯的一致性也较差（精囊kappa = 0.298；淋巴结kappa = 0.21）。
PET-CT PSMA显示出高特异性和NPV，但与最终组织病理学相比，敏感性、相关性和一致性较低。虽然有助于排除疾病，但其阳性结果应谨慎解读。
