The Journal of Nuclear Medicine ( IF 9.3 ) Pub Date : 2022-06-01 , DOI: 10.2967/jnumed.121.262398 Ida Sonni 1 , Ely R Felker 2 , Andrew T Lenis 3 , Anthony E Sisk 4 , Shadfar Bahri 5, 6 , Martin Allen-Auerbach 5, 6 , Wesley R Armstrong 5 , Voraparee Suvannarerg 2, 7 , Teeravut Tubtawee 2, 8 , Tristan Grogan 9 , David Elashoff 9 , Matthias Eiber 5, 10 , Steven S Raman 2 , Johannes Czernin 5, 6, 11 , Robert E Reiter 3, 6, 11 , Jeremie Calais 5, 6, 11
The role of prostate-specific membrane antigen (PSMA)–targeted PET in comparison to multiparametric MRI (mpMRI) in the evaluation of intraprostatic cancer foci is not well defined. The aim of our study was to compare the diagnostic performance of 68Ga-PSMA-11 PET/CT (PSMA PET/CT), mpMRI, and PSMA PET/CT + mpMRI using 3 independent masked readers for each modality and with histopathology as the gold standard in the detection, intraprostatic localization, and determination of local extension of primary prostate cancer. Methods: Patients with intermediate- or high-risk prostate cancer who underwent PSMA PET/CT as part of a prospective trial (NCT03368547) and mpMRI before radical prostatectomy were included. Each imaging modality was interpreted by 3 independent readers who were unaware of the other modality result. A central majority rule was applied (2:1). Pathologic examination of whole-mount slices was used as the gold standard. Imaging scans and whole-mount slices were interpreted using the same standardized approach on a segment level and a lesion level. A "neighboring" approach was used to define imaging–pathology correlation for the detection of individual prostate cancer foci. Accuracy in determining the location, extraprostatic extension (EPE), and seminal vesicle invasion (SVI) of prostate cancer foci was assessed using receiver-operating-characteristic curve analysis. Interreader agreement was calculated using intraclass correlation coefficient analysis. Results: The final analysis included 74 patients (14 [19%] with intermediate risk and 60 [81%] with high risk). The cancer detection rate (lesion-based analysis) was 85%, 83%, and 87% for PSMA PET/CT, mpMRI, and PSMA PET/CT + mpMRI, respectively. The change in AUC was statistically significant between PSMA PET/CT + mpMRI and the 2 imaging modalities alone for delineation of tumor localization (segment-based analysis) (P < 0.001) but not between PSMA PET/CT and mpMRI (P = 0.093). mpMRI outperformed PSMA PET/CT in detecting EPE (P = 0.002) and SVI (P = 0.001). In the segment-level analysis, intraclass correlation coefficient analysis showed moderate reliability among PSMA PET/CT and mpMRI readers using a 5-point Likert scale (range, 0.53–0.64). In the evaluation of T staging, poor reliability was found among PSMA PET/CT readers and poor to moderate reliability was found for mpMRI readers. Conclusion: PSMA PET/CT and mpMRI have similar accuracy in the detection and intraprostatic localization of prostate cancer foci. mpMRI performs better in identifying EPE and SVI. For the T-staging evaluation of intermediate to high-risk prostate cancer, mpMRI should still be considered the imaging modality of reference. Whenever available, PSMA PET/MRI or the coregistration or fusion of PSMA PET/CT and mpMRI (PSMA PET/CT + mpMRI) should be used as it improves tumor extent delineation.
中文翻译:
68Ga-PSMA-11 PET/CT 和 mpMRI 与组织病理学金标准在检测、前列腺内定位和确定原发性前列腺癌局部扩散方面的直接比较:前瞻性单中心成像试验的结果
与多参数 MRI (mpMRI) 相比,前列腺特异性膜抗原 (PSMA) 靶向 PET 在评估前列腺内癌灶方面的作用尚未明确。我们研究的目的是比较68 Ga-PSMA-11 PET/CT(PSMA PET/CT)、mpMRI 和 PSMA PET/CT + mpMRI 的诊断性能,每种模式使用 3 名独立的蒙面读者,并以组织病理学为依据检测、前列腺内定位和确定原发性前列腺癌局部扩展的金标准。方法:作为前瞻性试验 (NCT03368547) 的一部分接受 PSMA PET/CT 和根治性前列腺切除术前的 mpMRI 的中度或高风险前列腺癌患者被纳入。每种成像方式均由 3 名不知道其他方式结果的独立读者进行解读。采用中央多数规则 (2:1)。整片切片的病理检查作为金标准。在节段水平和病变水平上使用相同的标准化方法解释成像扫描和整体切片。“相邻”方法用于定义成像-病理学相关性以检测单个前列腺癌病灶。确定位置的准确性,前列腺外延伸 (EPE),使用接受者操作特征曲线分析评估前列腺癌病灶的精囊浸润 (SVI)。使用组内相关系数分析计算读者间协议。结果:最终分析包括 74 名患者(14 名 [19%] 为中等风险,60 名 [81%] 为高风险)。PSMA PET/CT、mpMRI 和 PSMA PET/CT + mpMRI 的癌症检出率(基于病变的分析)分别为 85%、83% 和 87%。AUC 的变化在 PSMA PET/CT + mpMRI 和单独用于描绘肿瘤定位的 2 种成像方式之间具有统计学意义(基于分段的分析)(P < 0.001),但在 PSMA PET/CT 和 mpMRI 之间没有差异(P = 0.093) . mpMRI 在检测 EPE ( P = 0.002) 和 SVI ( P= 0.001)。在分段水平分析中,组内相关系数分析显示 PSMA PET/CT 和 mpMRI 读取器使用 5 点李克特量表(范围 0.53–0.64)具有中等可靠性。在 T 分期评估中,PSMA PET/CT 阅读器的可靠性较差,mpMRI 阅读器的可靠性较差至中等。结论:PSMA PET/CT 和 mpMRI 在前列腺癌病灶的检测和前列腺内定位方面具有相似的准确性。mpMRI 在识别 EPE 和 SVI 方面表现更好。对于中高风险前列腺癌的 T 分期评估,mpMRI 仍应被视为参考成像方式。只要有可能,PSMA PET/MRI 或 PSMA PET/CT 和 mpMRI(PSMA PET/CT + mpMRI)的配准或融合都应使用,因为它可以改善肿瘤范围的描绘。