Prospective evaluation of the performance of [68Ga]Ga-PSMA-11 PET/CT(MRI) for lymph node staging in patients undergoing superextended salvage lymph node dissection after radical prostatectomy

European Journal of Nuclear Medicine - Tập 46 - Trang 2169-2177 - 2019
Mohammad Abufaraj1,2, Bernhard Grubmüller1,3, Markus Zeitlinger4,5, Gero Kramer1, Christian Seitz1,3, Andrea Haitel6, Pascal Baltzer3,7, Marcus Hacker8, Wolfgang Wadsak8,9, Sarah Pfaff8, Tomasz Wiatr10, Markus Mitterhauser5,8, Shahrokh F. Shariat1,11,12,13,14, Markus Hartenbach3,8
1Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
2Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
3Working Group of Diagnostic Imaging in Urology, Austrian Society of Urology, Vienna, Austria
4Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
5Ludwig Boltzmann Institute for Applied Diagnostics, Vienna, Austria
6Department of Pathology, Medical University of Vienna, Vienna, Austria
7Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
8Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
9Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria
10Department of Urology, Jagiellonian University, Collegium Medicum, Cracow, Poland
11Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
12Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA
13Department of Urology, Weill Cornell Medical College, New York, USA
14Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia

Tóm tắt

To assess the accuracy of [68Ga]-PSMA-11 PET/CT or [68Ga]-PSMA-11 PET/MRI (PSMA-11 PET/CT(MRI)) for lymph node (LN) staging using salvage LN dissection (SLND) in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). In a prospective study, 65 consecutive patients who developed BCR after RP underwent SLND after PSMA-11 PET/CT(MRI) between 2014 and 2018. Extended SLND up to the inferior mesenteric artery was performed in all patients. Regional and template-based correlations between the presence of LN metastases on histopathology and whole-body PSMA-11 PET/CT(MRI) results were evaluated. The diagnostic accuracy of PSMA-11 PET/CT(MRI) was also evaluated in relation to PSA level at the time of SLND. The median age of the patients at the time of SLND was 65 years (IQR 63–69 years) and the median PSA level was 1.4 ng/ml (IQR 0.8–2.9 ng/ml). Before SLND, 50 patients (77%) had additional therapy after RP (26.2% androgen-deprivation therapy and 50.8% radiotherapy). The median number of LNs removed on SLND was 40 (IQR 33–48) and the median number of positive nodes was 4 (IQR 2–6). LN metastases were seen in 13.8% of resected LNs (317 of 2,292). LNs positive on PSMA-11 PET/CT(MRI) had a median diameter of 7.2 mm (IQR 5.3–9 mm). Metastatic LNs in regions negative on PSMA-11 PET had a median diameter of 3.4 mm (IQR 2.1–5.4 mm). In a regional analysis, the sensitivity of PSMA-11 PET/CT(MRI) ranged from 72% to 100%, and the specificity from 96% to 100%. Region-specific positive and negative predictive values ranged from 95% to 100% and 93% to 100%, respectively. PSMA-11 PET/CT(MRI) has a very good performance for the identification of LN metastases in patients with BCR after RP. The high diagnostic accuracy in the regional and subregional analyses demonstrates the potential of this approach to enable a region-directed instead of a complete bilateral therapeutic intervention. The performance of PSMA-11 PET/CT(MRI) is dependent on the PSA level and the size of the metastatic deposit.

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European Journal of Nuclear Medicine

Tập 46

2169-2177

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