Ali Afshar-Oromieh1,2, Lars Peter Sattler3, Katja Steiger4, Tim Holland-Letz5, Marcelo Livorsi da Cunha6, Walter Mier3, Oliver Neels7,8, Klaus Kopka7,8, Wilko Weichert4,9, Uwe Haberkorn3,10. 1. Department of Nuclear Medicine, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany. a.afshar@gmx.de. 2. Department of Nuclear Medicine, Bern University Hospital (Inselspital), Bern, Switzerland. a.afshar@gmx.de. 3. Department of Nuclear Medicine, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany. 4. Institute of Pathology, Technical University of Munich, Munich, Germany. 5. Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany. 6. Department of Nuclear Medicine, Hospital Israelita Albert-Einstein, São Paulo, Brazil. 7. Division of Radiopharmaceutical Chemistry, German Cancer Research Center, Heidelberg, Germany. 8. German Cancer Consortium (DKTK), Heidelberg, Germany. 9. German Cancer Consortium (DKTK), Munich, Germany. 10. Department of Nuclear Medicine, Bern University Hospital (Inselspital), Bern, Switzerland.
Abstract
PURPOSE: Since the introduction of 68Ga-PSMA-11 PET/CT for imaging prostate cancer (PC) we have frequently observed mediastinal lymph nodes (LN) showing tracer uptake despite being classified as benign. The aim of this evaluation was to further analyze such LN. METHODS: Two patient groups with biphasic 68Ga-PSMA-11 PET/CT at 1 h and 3 h p.i. were included in this retrospective evaluation. Group A (n = 38) included patients without LN metastases, and group B (n = 43) patients with LN metastases of PC. SUV of mediastinal/paraaortal LN of group A (n = 100) were compared to SUV of LN metastases of group B (n = 91). Additionally, 22 randomly selected mediastinal and paraaortal LN of patients without PC were immunohistochemically (IHC) analyzed for PSMA expression. RESULTS: In group A, 7/38 patients (18.4%) presented with at least one PSMA-positive mediastinal LN at 1 h p.i. and 3/38 (7.9%) positive LN at 3 h p.i. with a SUVmax of 2.3 ± 0.7 at 1 h p.i. (2.0 ± 0.7 at 3 h p.i.). A total of 11 PSMA-positive mediastinal/paraaortal LN were detected in nine patients considering both imaging timing points. SUVmax of LN-metastases was 12.5 ± 13.2 at 1 h p.i. (15.8 ± 17.0 at 3 h p.i.). SUVmax increased clearly (> 10%) between 1 h and 3 h p.i. in 76.9% of the LN metastases, and decreased significantly in 72.7% of the mediastinal/paraaortal LN. By IHC, PSMA-expression was observed in intranodal vascular endothelia of all investigated LN groups and to differing degrees within germinal centers of 15/22 of them (68.1%). Expression was stronger in mediastinal nodes (p = 0.038) and when follicular hyperplasia was present (p = 0.050). CONCLUSION: PSMA-positive mediastinal/paraaortal benign LN were visible in a notable proportion of patients. PSMA-positivity on the histopathological level was associated with the activation state of the LN. However, in contrast to LN metastases of PC, they presented with significantly lower uptake, which, in addition, usually decreased over time.
PURPOSE: Since the introduction of 68Ga-PSMA-11 PET/CT for imaging prostate cancer (PC) we have frequently observed mediastinal lymph nodes (LN) showing tracer uptake despite being classified as benign. The aim of this evaluation was to further analyze such LN. METHODS: Two patient groups with biphasic 68Ga-PSMA-11 PET/CT at 1 h and 3 h p.i. were included in this retrospective evaluation. Group A (n = 38) included patients without LN metastases, and group B (n = 43) patients with LN metastases of PC. SUV of mediastinal/paraaortal LN of group A (n = 100) were compared to SUV of LN metastases of group B (n = 91). Additionally, 22 randomly selected mediastinal and paraaortal LN of patients without PC were immunohistochemically (IHC) analyzed for PSMA expression. RESULTS: In group A, 7/38 patients (18.4%) presented with at least one PSMA-positive mediastinal LN at 1 h p.i. and 3/38 (7.9%) positive LN at 3 h p.i. with a SUVmax of 2.3 ± 0.7 at 1 h p.i. (2.0 ± 0.7 at 3 h p.i.). A total of 11 PSMA-positive mediastinal/paraaortal LN were detected in nine patients considering both imaging timing points. SUVmax of LN-metastases was 12.5 ± 13.2 at 1 h p.i. (15.8 ± 17.0 at 3 h p.i.). SUVmax increased clearly (> 10%) between 1 h and 3 h p.i. in 76.9% of the LN metastases, and decreased significantly in 72.7% of the mediastinal/paraaortal LN. By IHC, PSMA-expression was observed in intranodal vascular endothelia of all investigated LN groups and to differing degrees within germinal centers of 15/22 of them (68.1%). Expression was stronger in mediastinal nodes (p = 0.038) and when follicular hyperplasia was present (p = 0.050). CONCLUSION:PSMA-positive mediastinal/paraaortal benign LN were visible in a notable proportion of patients. PSMA-positivity on the histopathological level was associated with the activation state of the LN. However, in contrast to LN metastases of PC, they presented with significantly lower uptake, which, in addition, usually decreased over time.
Authors: Ali Afshar-Oromieh; Lars Peter Sattler; Walter Mier; Boris A Hadaschik; Jürgen Debus; Tim Holland-Letz; Klaus Kopka; Uwe Haberkorn Journal: J Nucl Med Date: 2017-01-06 Impact factor: 10.057
Authors: Ali Afshar-Oromieh; Henrik Hetzheim; Clemens Kratochwil; Martina Benesova; Matthias Eder; Oliver C Neels; Michael Eisenhut; Wolfgang Kübler; Tim Holland-Letz; Frederik L Giesel; Walter Mier; Klaus Kopka; Uwe Haberkorn Journal: J Nucl Med Date: 2015-08-20 Impact factor: 10.057
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Authors: Maurits Wondergem; Friso M van der Zant; Remco J J Knol; Sergiy V Lazarenko; Jan Pruim; Igle J de Jong Journal: J Nucl Med Date: 2017-04-27 Impact factor: 10.057
Authors: Christian M Zechmann; Ali Afshar-Oromieh; Tom Armor; James B Stubbs; Walter Mier; Boris Hadaschik; John Joyal; Klaus Kopka; Jürgen Debus; John W Babich; Uwe Haberkorn Journal: Eur J Nucl Med Mol Imaging Date: 2014-02-28 Impact factor: 9.236
Authors: Ali Afshar-Oromieh; Henrik Hetzheim; Wolfgang Kübler; Clemens Kratochwil; Frederik L Giesel; Thomas A Hope; Matthias Eder; Michael Eisenhut; Klaus Kopka; Uwe Haberkorn Journal: Eur J Nucl Med Mol Imaging Date: 2016-06-03 Impact factor: 9.236
Authors: A Afshar-Oromieh; A Malcher; M Eder; M Eisenhut; H G Linhart; B A Hadaschik; T Holland-Letz; F L Giesel; C Kratochwil; S Haufe; U Haberkorn; C M Zechmann Journal: Eur J Nucl Med Mol Imaging Date: 2012-11-24 Impact factor: 9.236
Authors: Ali Afshar-Oromieh; Tim Holland-Letz; Frederik L Giesel; Clemens Kratochwil; Walter Mier; Sabine Haufe; Nils Debus; Matthias Eder; Michael Eisenhut; Martin Schäfer; Oliver Neels; Markus Hohenfellner; Klaus Kopka; Hans-Ulrich Kauczor; Jürgen Debus; Uwe Haberkorn Journal: Eur J Nucl Med Mol Imaging Date: 2017-05-12 Impact factor: 9.236
Authors: Ian Alberts; Jan-Niklas Hünermund; Christos Sachpekidis; Clemens Mingels; Viktor Fech; Karl Peter Bohn; Axel Rominger; Ali Afshar-Oromieh Journal: Eur Radiol Date: 2021-04-15 Impact factor: 5.315