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68Ga-PSMA PET/CT compared with MRI/CT and diffusion-weighted MRI for primary lymph node staging prior to definitive radiotherapy in prostate cancer: a prospective diagnostic test accuracy study

  • Lars J. PetersenEmail author
  • Julie B. Nielsen
  • Niels C. Langkilde
  • Astrid Petersen
  • Ali Afshar-Oromieh
  • Nandita M. De Souza
  • Katja De Paepe
  • Rune V. Fisker
  • Dennis T. Arp
  • Jesper Carl
  • Uwe Haberkorn
  • Helle D. Zacho
Original Article
  • 45 Downloads

Abstract

Background

The aim was to compare the diagnostic accuracy of 68Ga-PSMA PET/CT with conventional cross-sectional imaging and diffusion-weighted MRI (DW-MRI) for detecting lymph node metastasis (LNM) to stage prostate cancer patients. Twenty consecutive, newly- diagnosed prostate cancer patients were prospectively enrolled and underwent 68Ga-PSMA-11 PET/CT, anatomical MRI or contrast-enhanced CT, and DW-MRI prior to laparoscopic, template-based, extended lymph node dissection. Histopathological findings served as the reference test.

Results

Histopathology showed LNM in 13 of 20 patients (19 high-risk, 1 intermediate risk). Five patients had metastasis-suspected lymph nodes on 68Ga-PSMA PET/CT. Patient-based analysis showed that the sensitivity and specificity for detecting LNM were 39% and 100% with 68Ga-PSMA PET/CT, 8% and 100% with MRI/CT, and 36% and 83% with DW-MRI, respectively. The positive and negative predictive values were 100% and 49% with 68Ga-PSMA PET/C, 100% and 37% with MRI/CT, and 80% and 42% with DW-MRI. Of 573 dissected lymph nodes, 33 were LNM from 26 regions. True-positive LNM on 68Ga-PSMA PET/CT was 9–11 mm in diameter, whereas false-negative LNM had a median diameter of 4 mm, with only 3 of 30 lymph nodes being larger than 10 mm. LNM were positive for PSMA by immunostaining.

Conclusions

The sensitivity of 68Ga-PSMA PET/CT was notably better than that of MRI/CT and comparable to that of DW-MRI. Some false positive findings with DW-MRI reduced its specificity and positive predictive value compared with those of 68Ga-PSMA PET/CT and MRI/CT.

Keywords

Anatomical cross-sectional imaging Diagnostic accuracy Prostatic neoplasm PSMA PET/CT Staging 

Notes

Author contributions

LJP, HDZ, NCL, UH, and JBNP contributed to the conception and design of the study; JBN, NCL, AP, DTA, and JC contributed to the acquisition of data; HDZ, AAO, RVF, NMDS, and KDP evaluated the imaging data; LJP, JBN, and HDZ performed the analysis/interpretation of data; LJP, JBN, and HDZ drafted the manuscript. All authors critically revised the manuscript and approved the final version of the manuscript.

Funding

The study was supported by an unrestricted Grant from the Obel Family Foundation (Grant no. 26063).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This clinical study was approved by the Danish Health and Medicine Authority, the Danish Data Protection Agency, and the Northern Denmark Region Committee in Health Research Ethics (N-20140079). The protocol was registered in the EudraCT database (#2014-004210-28).

Consent to participate

All patients received written and oral information and provided written informed consent.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Lars J. Petersen
    • 1
    • 2
    Email author
  • Julie B. Nielsen
    • 1
    • 2
  • Niels C. Langkilde
    • 2
    • 3
  • Astrid Petersen
    • 4
  • Ali Afshar-Oromieh
    • 5
  • Nandita M. De Souza
    • 6
  • Katja De Paepe
    • 6
  • Rune V. Fisker
    • 1
    • 7
  • Dennis T. Arp
    • 8
  • Jesper Carl
    • 8
    • 9
  • Uwe Haberkorn
    • 10
    • 11
  • Helle D. Zacho
    • 1
    • 2
  1. 1.Department of Nuclear MedicineAalborg University HospitalAalborgDenmark
  2. 2.Department of Clinical MedicineAalborg UniversityAalborgDenmark
  3. 3.Department of UrologyAalborg University HospitalAalborgDenmark
  4. 4.Department of PathologyAalborg University HospitalAalborgDenmark
  5. 5.Department of Nuclear MedicineBern University HospitalBernSwitzerland
  6. 6.The Institute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUK
  7. 7.Department of RadiologyAalborg University HospitalAalborgDenmark
  8. 8.Department of Medical PhysicsAalborg University HospitalAalborgDenmark
  9. 9.Department of OncologyNaestved Sygehus, Zealand University HospitalNaestvedDenmark
  10. 10.Department of Nuclear MedicineUniversity Hospital HeidelbergHeidelbergGermany
  11. 11.Clinical Cooperation Unit Nuclear MedicineDKFZHeidelbergGermany

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