Hinkle G H, Burgers J K, Neal C E, Texter J H, Kahn D, Williams R D, Maguire R, Rogers B, Olsen J O, Badalament R A
Department of Radiology, The Ohio State University Medical Center, Columbus 43210, USA.
Cancer. 1998 Aug 15;83(4):739-47.
Optimum therapy for prostate carcinoma patients requires accurate staging, but computed tomography (CT) and magnetic resonance imaging (MRI) have limitations as methods for detecting soft tissue metastases. In this study, radioimmunoscintigraphy (RIS) was evaluated for its ability to identify sites of metastatic disease in lymph nodes.
RIS was evaluated in 51 prostate carcinoma patients at high risk for metastatic disease. An intravenous infusion of indium-111 capromab pendetide was given, followed by nuclear medicine imaging on two separate dates. Bilateral, open pelvic lymph node dissection was performed with additional exploration and biopsy of scan positive extraprostatic regions. Histologic evaluation of removed tissue confirmed the accuracy of RIS. In addition, results were compared with other standard methods for diagnosing patients prior to surgery.
Nineteen patients (37%) had evidence of lymph node involvement with RIS. Fifteen of the 19 positive patients had pathologic evidence of cancer in the biopsied lymph nodes. Sensitivity, specificity, accuracy, and the positive predictive value for detection of extraprostatic disease were 75%, 86%, 81%, and 79%, respectively. CT, MRI, and ultrasound of the pelvis demonstrated a combined accuracy of only 48% in detecting lymph node disease. Twenty-five previously undetected sites were deemed positive with RIS. Fourteen of these were biopsy-proven tumor sites, seven were probable tumor sites, and four were assumed to be false-positive.
RIS had an impact on patient management through its detection of occult disease in more than 50% of prostate carcinoma patients studied, and it provided information concerning the likelihood that lymph node metastases would be found during surgery.
前列腺癌患者的最佳治疗需要准确分期，但计算机断层扫描（CT）和磁共振成像（MRI）作为检测软组织转移的方法存在局限性。在本研究中，对放射免疫闪烁显像（RIS）识别淋巴结转移病灶的能力进行了评估。
对51例有转移疾病高风险的前列腺癌患者进行了RIS评估。静脉注射铟-111卡普单抗喷地肽，随后在两个不同日期进行核医学成像。进行双侧开放性盆腔淋巴结清扫，并对扫描阳性的前列腺外区域进行额外探查和活检。对切除组织的组织学评估证实了RIS的准确性。此外，将结果与术前诊断患者的其他标准方法进行了比较。
19例（37%）患者经RIS检查有淋巴结受累证据。19例阳性患者中有15例在活检淋巴结中有癌症病理证据。检测前列腺外疾病的敏感性、特异性、准确性和阳性预测值分别为75%、86%、81%和79%。盆腔CT、MRI和超声检测淋巴结疾病的综合准确率仅为48%。25个先前未检测到的部位经RIS检查被判定为阳性。其中14个为活检证实的肿瘤部位，7个为可能的肿瘤部位，4个被认为是假阳性。
RIS通过在超过50%的研究前列腺癌患者中检测出隐匿性疾病，对患者管理产生了影响，并提供了有关手术中发现淋巴结转移可能性的信息。
