Shoji Kimura1,2, Mohammad Abufaraj1,3, Florian Janisch1,4, Takehiro Iwata1,5, Mehdi Kardoust Parizi1,6, Beat Foerster1,7, Nicola Fossati8,9, Alberto Briganti8,9, Shin Egawa2, Markus Hartenbach10, Shahrokh F Shariat11,12,13,14,15. 1. Department of Urology, Medical University of Vienna, Vienna, Austria. 2. Department of Urology, Jikei University School of Medicine, Tokyo, Japan. 3. Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan. 4. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 5. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 6. Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 7. Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland. 8. Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. 9. Vita-Salute San Raffaele University, Milan, Italy. 10. Department of Biomedical Imaging and Image Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria. 11. Department of Urology, Medical University of Vienna, Vienna, Austria. shahrokh.shariat@meduniwien.ac.at. 12. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. shahrokh.shariat@meduniwien.ac.at. 13. Department of Urology, Weill Cornell Medical College, New York, NY, USA. shahrokh.shariat@meduniwien.ac.at. 14. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. shahrokh.shariat@meduniwien.ac.at. 15. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. shahrokh.shariat@meduniwien.ac.at.
Abstract
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.
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.
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Authors: Katharina Sprute; Vasko Kramer; Stefan A Koerber; Manuel Meneses; Rene Fernandez; Cristian Soza-Ried; Mathias Eiber; Wolfgang A Weber; Isabel Rauscher; Kambiz Rahbar; Michael Schaefers; Tadashi Watabe; Motohide Uemura; Sadahiro Naka; Norio Nonomura; Jun Hatazawa; Constantin Schwab; Viktoria Schütz; Markus Hohenfellner; Tim Holland-Letz; Juergen Debus; Clemens Kratochwil; Horacio Amaral; Pete L Choyke; Uwe Haberkorn; Camilo Sandoval; Frederik L Giesel Journal: J Nucl Med Date: 2020-08-17 Impact factor: 10.057