研究动态
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前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描与骨扫描在前列腺癌诊断时检测骨转移的个体内比较。

Intra-individual comparison of prostate-specific membrane antigen positron emission tomography/computed tomography versus bone scan in detecting skeletal metastasis at prostate cancer diagnosis.

发表日期:2023 Nov 09
作者: Ramesh Shanmugasundaram, Jeremy Saad, Ash Heyworth, Veronica Wong, Anita Pelecanos, Mohan Arianayagam, Bertram Canagasingham, Richard Ferguson, Ahmed Saeed Goolam, Mohamed Khadra, Jonathan Kam, Raymond Ko, Stephen McCombie, Celi Varol, Matthew Winter, Robert Mansberg, Diep Nguyen, Chuong Bui, Han Loh, Ken Le, Matthew J Roberts
来源: BJU INTERNATIONAL

摘要:

比较 68 Ga 前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描 (PSMA PET/CT) 与 99 Tc 全身骨扫描 (WBBS) 的诊断性能和放射分期影响,以检测骨转移前列腺癌 (PCa) 的主要分期。前瞻性机构数据库对在 1 周间隔内接受 PSMA PET 和 WBBS 进行 PCa 主要分期的患者进行了回顾性检查。根据核医学医师的解释,病变被分类为“阴性”、“模棱两可”或“明确”。根据三组对每种成像方式的转移负荷进行表征:(i) 局部疾病(无骨骼转移),(ii) 寡转移疾病(三个或更少的骨骼转移),或 (iii) 多转移疾病(超过三个骨骼转移) .共纳入667名患者。中位(四分位数范围)前列腺特异性抗原水平为 9.2(6.2-16)ng/mL,根据修改后的 D'Amico 风险分类,60% 的患者属于高风险。两次扫描中骨骼转移检测的总体分布发生了变化(P = 0.003),在高风险组(P = 0.030)和低风险组(P = 0.018)中保持不变。与 WBBS 总体相比(10.3% vs 7.3%),并且根据风险分组(高:12% vs 9%,中:4% vs 1%),PSMA PET/CT 识别出更明确的骨骼转移。 PSMA PET/CT 的分期比 WBBS 更常见 (P = 0.001)。原发肿瘤的最大标准化摄取值(SUVmax)与 PSMA PET/CT 上骨转移的分期上调相关(P = 0.025),而年龄与 WBBS 上的分期上调相关(P = 0.021)。根据转移灶的范围,原发肿瘤和转移灶的 SUVmax 均较高(分别为 P = 0.001 和 P < 0.001)。 PSMA PET/CT 比 WBBS 检测到更多的骨骼转移,导致升期率较高,主要发生在高危患者。原发肿瘤和转移瘤的 SUVmax 与分期相关。© 2023 BJU International。
To compare the diagnostic performance and radiological staging impact of 68 Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) compared to 99 Tc whole-body bone scan (WBBS) for the detection of skeletal metastasis in the primary staging of prostate cancer (PCa).A prospective institutional database was retrospectively examined for patients who underwent both PSMA PET and WBBS within a 1 week interval for PCa primary staging. Lesions were categorised as 'negative', 'equivocal', or 'definite' based on nuclear medicine physician interpretation. Metastatic burden was characterised for each imaging modality according to three groups: (i) local disease (no skeletal metastases), (ii) oligometastatic disease (three or fewer skeletal metastases), or (iii) polymetastatic disease (more than three skeletal metastases).There were 667 patients included. The median (interquartile range) prostate-specific antigen level was 9.2 (6.2-16) ng/mL and 60% of patients were high risk according to a modified D'Amico risk classification. The overall distribution of skeletal metastasis detection changed across the two scans overall (P = 0.003), being maintained within high-risk (P = 0.030) and low-risk (P = 0.018) groups. PSMA PET/CT identified more definite skeletal metastases compared to WBBS overall (10.3% vs 7.3%), and according to risk grouping (high: 12% vs 9%, intermediate: 4% vs 1%). Upstaging was more common with PSMA PET/CT than WBBS (P = 0.001). The maximum standardised uptake value (SUVmax ) of the primary tumour was associated with upstaging of skeletal metastases on PSMA PET/CT (P = 0.025), while age was associated with upstaging on WBBS (P = 0.021). The SUVmax of the primary tumour and metastases were both higher according to extent of metastatic disease (P = 0.001 and P < 0.001, respectively).More skeletal metastases were detected with PSMA PET/CT than WBBS, resulting in a higher upstaging rate mostly in high-risk patients. The SUVmax of the primary tumour and metastases was associated with upstaging.© 2023 BJU International.