Isabel Rauscher1, Tobias Maurer2, Ambros J Beer3, Frank-Philipp Graner4, Bernhard Haller5, Gregor Weirich6, Alan Doherty7, Jürgen E Gschwend2, Markus Schwaiger4, Matthias Eiber4. 1. Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany isabel.rauscher@tum.de. 2. Department of Urology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany. 3. Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany. 4. Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany. 5. Institute of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany. 6. Department of Pathology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; and. 7. Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom.
Abstract
The purpose of this study was to evaluate the accuracy of Glu-NH-CO-NH-Lys-(Ahx)-[68Ga(HBED-CC)] PET compared with morphologic imaging for the assessment of lymph node metastases (LNM) in patients with recurrent prostate cancer. METHODS: Forty-eight patients (median age, 71 y; interquartile range, 66-74 y) with biochemical recurrence (median prostate-specific antigen level, 1.31 ng/mL; interquartile range, 0.75-2.55 ng/mL) who underwent 68Ga-prostate-specific membrane antigen (PSMA) HBED-CC PET/CT or PET/MR and salvage lymphadenectomy were retrospectively included. Institutional review board approval and written informed consent were obtained from all patients for the purpose of anonymized evaluation and publication of their data. Standardized predefined lymph node (LN) template fields (n = 10) were evaluated in 68Ga-PSMA HBED-CC PET and morphologic imaging for the presence of LNM using a 5-point-scale. Additionally, SUVmean/max and size of suspicious lesions were determined. Specificity of 68Ga-PSMA HBED-CC PET imaging for PET-positive LNs was defined by comparison to histopathology. The diagnostic accuracy of 68Ga-PSMA HBED-CC PET compared with morphologic imaging alone was assessed, and areas under the receiver-operating-characteristic curves are presented. RESULTS: LNM were found histologically in 68 of 179 resected anatomic LN fields (38.0%). The specificity of 68Ga-PSMA HBED-CC PET and morphologic imaging was 97.3% and 99.1%, respectively. However, 68Ga-PSMA HBED-CC PET detected LNM in 53 of 68 histopathologically proven metastatic LN fields (77.9%) whereas morphologic imaging was positive in only 18 of 67 (26.9%). 68Ga-PSMA HBED-CC PET imaging performed significantly superior to morphologic imaging for detection of LNM (difference in the areas under the receiver-operating-characteristic curves, 0.139; 95% confidence interval, 0.063-0.214; P < 0.001). In 68Ga-PSMA HBED-CC PET, the mean size of PET-positive LN measured by CT or MRI was 8.3 ± 4.3 mm (range, 4-25 mm), and LNs, which were suspicious only in CT or MRI, presented with a mean size of 13.0 ± 4.9 mm (range, 8-25 mm). CONCLUSION: 68Ga-PSMA HBED-CC PET imaging is a promising method for early detection of LNM in patients with biochemical recurrent prostate cancer. It is more accurate than morphologic imaging and thus might represent a valuable tool for guiding salvage lymphadenectomy.
The purpose of this study was to evaluate the accuracy of Glu-NH-CO-NH-Lys-(Ahx)-[68Ga(HBED-CC)] PET compared with morphologic imaging for the assessment of lymph node metastases (LNM) in patients with recurrent prostate cancer. METHODS: Forty-eight patients (median age, 71 y; interquartile range, 66-74 y) with biochemical recurrence (median prostate-specific antigen level, 1.31 ng/mL; interquartile range, 0.75-2.55 ng/mL) who underwent 68Ga-prostate-specific membrane antigen (PSMA) HBED-CC PET/CT or PET/MR and salvage lymphadenectomy were retrospectively included. Institutional review board approval and written informed consent were obtained from all patients for the purpose of anonymized evaluation and publication of their data. Standardized predefined lymph node (LN) template fields (n = 10) were evaluated in 68Ga-PSMA HBED-CC PET and morphologic imaging for the presence of LNM using a 5-point-scale. Additionally, SUVmean/max and size of suspicious lesions were determined. Specificity of 68Ga-PSMA HBED-CC PET imaging for PET-positive LNs was defined by comparison to histopathology. The diagnostic accuracy of 68Ga-PSMA HBED-CC PET compared with morphologic imaging alone was assessed, and areas under the receiver-operating-characteristic curves are presented. RESULTS: LNM were found histologically in 68 of 179 resected anatomic LN fields (38.0%). The specificity of 68Ga-PSMA HBED-CC PET and morphologic imaging was 97.3% and 99.1%, respectively. However, 68Ga-PSMA HBED-CC PET detected LNM in 53 of 68 histopathologically proven metastatic LN fields (77.9%) whereas morphologic imaging was positive in only 18 of 67 (26.9%). 68Ga-PSMA HBED-CC PET imaging performed significantly superior to morphologic imaging for detection of LNM (difference in the areas under the receiver-operating-characteristic curves, 0.139; 95% confidence interval, 0.063-0.214; P < 0.001). In 68Ga-PSMA HBED-CC PET, the mean size of PET-positive LN measured by CT or MRI was 8.3 ± 4.3 mm (range, 4-25 mm), and LNs, which were suspicious only in CT or MRI, presented with a mean size of 13.0 ± 4.9 mm (range, 8-25 mm). CONCLUSION: 68Ga-PSMA HBED-CC PET imaging is a promising method for early detection of LNM in patients with biochemical recurrent prostate cancer. It is more accurate than morphologic imaging and thus might represent a valuable tool for guiding salvage lymphadenectomy.
Authors: Maria Vinsensia; Peter L Chyoke; Boris Hadaschik; Tim Holland-Letz; Jan Moltz; Klaus Kopka; Isabel Rauscher; Walter Mier; Markus Schwaiger; Uwe Haberkorn; Tobias Mauer; Clemens Kratochwil; Matthias Eiber; Frederik L Giesel Journal: J Nucl Med Date: 2017-06-21 Impact factor: 10.057
Authors: Thomas A Hope; Jeremy Z Goodman; Isabel E Allen; Jeremie Calais; Wolfgang P Fendler; Peter R Carroll Journal: J Nucl Med Date: 2018-12-07 Impact factor: 10.057
Authors: Jeremie Calais; Johannes Czernin; Minsong Cao; Amar U Kishan; John V Hegde; Narek Shaverdian; Kiri Sandler; Fang-I Chu; Chris R King; Michael L Steinberg; Isabel Rauscher; Nina-Sophie Schmidt-Hegemann; Thorsten Poeppel; Philipp Hetkamp; Francesco Ceci; Ken Herrmann; Wolfgang P Fendler; Matthias Eiber; Nicholas G Nickols Journal: J Nucl Med Date: 2017-11-09 Impact factor: 10.057
Authors: Martin T Freitag; Jan P Radtke; Ali Afshar-Oromieh; Matthias C Roethke; Boris A Hadaschik; Martin Gleave; David Bonekamp; Klaus Kopka; Matthias Eder; Thorsten Heusser; Marc Kachelriess; Kathrin Wieczorek; Christos Sachpekidis; Paul Flechsig; Frederik Giesel; Markus Hohenfellner; Uwe Haberkorn; Heinz-Peter Schlemmer; A Dimitrakopoulou-Strauss Journal: Eur J Nucl Med Mol Imaging Date: 2016-12-17 Impact factor: 9.236