Cordula A Jilg1, Wolfgang Schultze-Seemann2, Vanessa Drendel2, Werner Vach2, Gesche Wieser2, Tobias Krauss2, Anett Jandausch2, Stefanie Hölz2, Karl Henne2, Sven N Reske2, Anca-L Grosu2, Wolfgang A Weber2, H Christian Rischke2. 1. Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York. Electronic address: cordula.jilg@uniklinik-freiburg.de. 2. Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
Abstract
PURPOSE: We evaluated the diagnostic accuracy of choline positron emission tomography/computerized tomography for nodal relapse of prostate cancer according to topographical site and tumor infiltration size in lymph nodes. MATERIALS AND METHODS: A total of 72 patients with nodal prostate cancer relapse after primary therapy underwent pelvic and/or retroperitoneal salvage lymph node dissection. Salvage was done after whole body positron emission tomography/computerized tomography with (11)C-choline or (18)F-fluoroethylcholine showed positron emission tomography positive lymph nodes but no other detectable metastasis. Diagnostic accuracy was evaluated in 160 dissected lymph node regions (pelvic left/right and retroperitoneal), 498 subregions (common, external and internal iliac, obturator, presacral, aortic bifurcation, aortal, vena caval and interaortocaval) and 2,122 lymph nodes. RESULTS: Lymph node metastasis was present in 32% of resected lymph nodes (681 of 2,122), resulting in 238 positive subregions and 111 positive regions. Positron emission tomography/computerized tomography was positive for 110 regions and 209 subregions. Sensitivity, specificity, positive and negative predictive values, and accuracy were 91.9%, 83.7%, 92.7%, 82.0% and 89.4% (region based), 80.7%, 93.5%, 91.9%, 84.1% and 87.3% (subregion based), and 57.0%, 98.4%, 94.5%, 82.6% and 84.9% (lesion based), respectively. Of 393 positive lymph node metastases detected by this method 278 (70.7%) were in lymph nodes with a less than 10 mm short axis diameter. Imaging sensitivity was 13.3%, 57.4% and 82.8% for a tumor infiltration depth of 2 or greater to less than 3 mm, 5 or greater to less than 6 mm and 10 or greater to less than 11 mm, respectively. Lymph node metastasis site and the radiotracer ((11)C-choline/(18)F-fluoroethylcholine) had no substantial impact on diagnostic accuracy. CONCLUSIONS: Choline positron emission tomography/computerized tomography detects affected lymph node regions (pelvic left/right and retroperitoneal) in patients with prostate cancer relapse with high accuracy and it seems helpful for guiding salvage lymph node dissection. Sensitivity decreases with the size of metastatic infiltration in lymph nodes. This technique detects metastasis in a significant fraction of lymph nodes that are not pathologically enlarged on computerized tomography.
PURPOSE: We evaluated the diagnostic accuracy of choline positron emission tomography/computerized tomography for nodal relapse of prostate cancer according to topographical site and tumor infiltration size in lymph nodes. MATERIALS AND METHODS: A total of 72 patients with nodal prostate cancer relapse after primary therapy underwent pelvic and/or retroperitoneal salvage lymph node dissection. Salvage was done after whole body positron emission tomography/computerized tomography with (11)C-choline or (18)F-fluoroethylcholine showed positron emission tomography positive lymph nodes but no other detectable metastasis. Diagnostic accuracy was evaluated in 160 dissected lymph node regions (pelvic left/right and retroperitoneal), 498 subregions (common, external and internal iliac, obturator, presacral, aortic bifurcation, aortal, vena caval and interaortocaval) and 2,122 lymph nodes. RESULTS: Lymph node metastasis was present in 32% of resected lymph nodes (681 of 2,122), resulting in 238 positive subregions and 111 positive regions. Positron emission tomography/computerized tomography was positive for 110 regions and 209 subregions. Sensitivity, specificity, positive and negative predictive values, and accuracy were 91.9%, 83.7%, 92.7%, 82.0% and 89.4% (region based), 80.7%, 93.5%, 91.9%, 84.1% and 87.3% (subregion based), and 57.0%, 98.4%, 94.5%, 82.6% and 84.9% (lesion based), respectively. Of 393 positive lymph node metastases detected by this method 278 (70.7%) were in lymph nodes with a less than 10 mm short axis diameter. Imaging sensitivity was 13.3%, 57.4% and 82.8% for a tumor infiltration depth of 2 or greater to less than 3 mm, 5 or greater to less than 6 mm and 10 or greater to less than 11 mm, respectively. Lymph node metastasis site and the radiotracer ((11)C-choline/(18)F-fluoroethylcholine) had no substantial impact on diagnostic accuracy. CONCLUSIONS:Choline positron emission tomography/computerized tomography detects affected lymph node regions (pelvic left/right and retroperitoneal) in patients with prostate cancer relapse with high accuracy and it seems helpful for guiding salvage lymph node dissection. Sensitivity decreases with the size of metastatic infiltration in lymph nodes. This technique detects metastasis in a significant fraction of lymph nodes that are not pathologically enlarged on computerized tomography.
Authors: H Christian Rischke; Teresa Beck; Werner Vach; Gesche Wieser; Anca L Grosu; Wolfgang Schultze-Seemann; Philipp T Meyer; Cordula A Jilg Journal: Eur J Nucl Med Mol Imaging Date: 2014-06-21 Impact factor: 9.236
Authors: Henrik Kjölhede; Göran Ahlgren; Helen Almquist; Fredrik Liedberg; Kerstin Lyttkens; Thomas Ohlsson; Ola Bratt Journal: World J Urol Date: 2015-04-01 Impact factor: 4.226
Authors: Cordula A Jilg; Vanessa Drendel; H Christian Rischke; Teresa I Beck; Kathrin Reichel; Malte Krönig; Ulrich Wetterauer; Wolfgang Schultze-Seemann; Philipp T Meyer; Werner Vach Journal: J Nucl Med Date: 2019-01-25 Impact factor: 10.057
Authors: Andre Abreu; Carlos Fay; Daniel Park; David Quinn; Tanya Dorff; John Carpten; Peter Kuhn; Parkash Gill; Fabio Almeida; Inderbir Gill Journal: BJU Int Date: 2017-01-14 Impact factor: 5.969
Authors: Cordula A Jilg; Anja Leifert; Daniel Schnell; Simon Kirste; Natalia Volegova-Neher; Daniel Schlager; Gesche Wieser; Karl Henne; Wolfgang Schultze-Seemann; Anca-L Grosu; Hans Christian Rischke Journal: Radiat Oncol Date: 2014-08-12 Impact factor: 3.481