Performance of [68Ga] Ga-PSMA 11 PET for detecting prostate cancer in the lymph nodes before salvage lymph node dissection: a systematic review and meta-analysis.,Prostate Cancer and Prostatic Diseases

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Performance of [68Ga] Ga-PSMA 11 PET for detecting prostate cancer in the lymph nodes before salvage lymph node dissection: a systematic review and meta-analysis.
Prostate Cancer and Prostatic Diseases ( IF 5.1 ) Pub Date : 2019-05-30 , DOI: 10.1038/s41391-019-0156-z
Shoji Kimura _{1,

2} , Mohammad Abufaraj _{1,

3} , Florian Janisch _{1,

4} , Takehiro Iwata _{1,

5} , Mehdi Kardoust Parizi _{1,

6} , Beat Foerster _{1,

7} , Nicola Fossati _{8,

9} , Alberto Briganti _{8,

9} , Shin Egawa ₂ , Markus Hartenbach ₁₀ , Shahrokh F Shariat _{1,

11,

12,

13,

14}

Affiliation

Department of Urology, Medical University of Vienna, Vienna, Austria.
Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
Department of Biomedical Imaging and Image Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
Department of Urology, Weill Cornell Medical College, New York, NY, USA.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.

BACKGROUND Salvage lymph node dissection (sLND) for nodal recurrence in prostate cancer (PCa) patients with biochemical recurrence (BCR) is still not recommended in current guidelines, because of the diagnostic inaccuracy of current conventional imaging. To assess the performance of [68Ga] Ga-prostate-specific membrane antigen conjugate 11 positron emission tomography (PSMA-PET) in detecting PCa lymph node metastasis using pathologic confirmation through sLND. METHODS Literature search was conducted using the MEDLINE, SCOPUS, Web of Science, and Cochrane Library on November 11th, 2018 to identify the eligible studies. Studies were eligible if they investigated the diagnostic performance of PSMA-PET before sLND in PCa patients with BCR and reported the number of true positive, false positive, false negative, and true negative on a lesion-based and/or field-based analyses to compare with histopathologic findings in sLND specimens. RESULTS Fourteen studies published between 2015 and 2018 comprising 462 patients were selected in this systematic review and meta-analysis. The positive predictive value of PSMA-PET before sLND on a patient-based analysis ranged between 0.70 and 0.93. The pooled sensitivity using lesion-based and field-based analyses were 0.84 (95%CI: 0.61-0.95) and 0.82 (95%CI: 0.72-0.89), respectively. The pooled specificity using lesion-based and field-based analyses were 0.97 (95%CI: 0.95-0.99) and 0.95 (95%CI: 0.70-0.99), respectively. The diagnostic odds ratio using lesion-based and field-based analyses were 189 (95%CI: 39-920) and 82 (95%CI: 8-832), respectively. CONCLUSIONS PSMA-PET before sLND provided highly accurate performance with clinically relevant high positive and negative predictive values for detecting lymph node disease in patients with BCR after local treatment with curative intent for PCa. PSMA-PET can identify the patients who are likely to benefit from sLND and possibly direct to lesion or region-based dissection.

中文翻译：

[68Ga] Ga-PSMA 11 PET在抢救淋巴结清扫术前检测淋巴结中前列腺癌的性能：系统评价和荟萃分析。

背景技术由于当前常规成像的诊断准确性，在当前指南中仍不建议在具有生化复发（BCR）的前列腺癌（PCa）患者中进行淋巴结清扫术（sLND）用于结节复发。为了评估[68Ga] Ga-前列腺特异性膜抗原缀合物11正电子发射断层扫描（PSMA-PET）在通过sLND进行病理学证实中检测PCa淋巴结转移中的性能。方法于2018年11月11日使用MEDLINE，SCOPUS，Web of Science和Cochrane图书馆进行文献检索，以鉴定符合条件的研究。如果研究调查了sLND之前PSMA-PET在PCa BCR患者中的诊断性能，并且报告了真正阳性，假阳性，假阴性，对基于病变和/或基于野外的分析与sLND标本中的组织病理学结果进行比较，则为“真”阴性。结果在本系统评价和荟萃分析中选择了2015年至2018年间发表的包括462例患者的14项研究。在基于患者的分析中，sLND之前PSMA-PET的阳性预测值介于0.70至0.93之间。使用基于病变和基于现场的分析得出的合并敏感性分别为0.84（95％CI：0.61-0.95）和0.82（95％CI：0.72-0.89）。使用基于病灶的分析和基于野外分析的合并特异性分别为0.97（95％CI：0.95-0.99）和0.95（95％CI：0.70-0.99）。使用基于病变和基于现场的分析得出的诊断几率分别为189（95％CI：39-920）和82（95％CI：8-832）。结论sLND之前的PSMA-PET可提供高度准确的性能，并具有临床相关的高阳性和阴性预测值，可在PCa根治性治疗后检测BCR患者的淋巴结疾病。PSMA-PET可以识别出可能受益于sLND并可能直接用于病变或基于区域的解剖的患者。

更新日期：2019-11-18

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