陈科 1贾卓 2刘亚超 3牛少曦 2王保军 2马鑫2
作者信息
- 1. 解放军医学院,北京 100853||解放军总医院第三医学中心泌尿外科医学部,北京 100853
- 2. 解放军总医院第三医学中心泌尿外科医学部,北京 100853
- 3. 解放军总医院第一医学中心核医学科,北京 100853
- 折叠
摘要
Abstract
Background There are still limitations in evaluating pelvic lymph node metastasis and local invasion of prostate cancer using single imaging examination such as 18F-DCFPyL PET/CT or multi-parameter magnetic resonance imaging(mpMRI).Objective To compare the diagnostic efficacy of 18F-DCFPyL PET/CT and mpMRI alone or in combination for intermediate to high-risk prostate cancer with pelvic lymph node metastasis,extraprostatic extension and seminal vesicle invasion.Methods Clinical data about patients with intermediate to high-risk prostate cancer who underwent 18F-DCFPyL PET/CT and mpMRI with robotic-assisted laparoscopic radical prostatectomy(RARP)and expanded pelvic lymph node dissection(ePLND)in Chinese PLA General Hospital from January 2018 to June 2022 were retrospectively analyzed.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of 18F-DCFPyL PET/CT,mpMRI and the combination of both for the diagnosis of pelvic lymph node metastasis,extraprostatic extension and seminal vesicle invasion in prostate cancer were compared using the postoperative pathological results as the gold standard.Results A total of 74 patients with intermediate to high-risk prostate cancer were included,with a mean age of(66.8±6.7)years.There were 26 cases(35.1%)in the intermediate-risk group and 48 cases(64.9%)in the high-risk group.The median tPSA value was 15.3(IQR:9.4～26.1)ng/mL,and the preoperative Gleason score was 7 in 33 cases,8 in 20 cases and≥9 in 21 cases.18F-DCFPyL PET/CT had higher sensitivity(57.1%vs 28.6%),specificity(98.5%vs 97%),and AUC(0.78 vs 0.63,P=0.106)compared to mpMRI in the diagnosis of pelvic lymph node metastases,and the combination of the two did not show better diagnostic performance(AUC:0.76 vs 0.78,P=0.154).In detecting seminal vesicle invasion,using mpMRI alone had higher sensitivity(66.7%vs 58.3%)and specificity(95.2%vs 91.9%)than 18F-DCFPyL PET/CT,with a higher AUC(0.83 vs 0.75,P=0.185),and the combination of the two didn't improve the diagnostic performance significantly(AUC:0.83 vs 0.81,P=0.690).In the diagnosis of extraprostatic invasion,the use of mpMRI had higher AUC compared to 18F-DCFPyL PET/CT alone(0.75 vs 0.64,P=0.007),and no significant improvement was seen when the two were combined(AUC:0.73 vs 0.75,P=0.152).Conclusion The preoperative combination of mpMRI with 18F-DCFPyL PET/CT may be useful in assessing seminal vesicle invasion in prostate cancer.The use of 18F-DCFPyL PET/CT alone,which is highly specific for the diagnosis of pelvic lymph node metastases in intermediate-to-high-risk prostate cancer,can help in making decisions about whether to perform pelvic lymph node dissection.However,the use of mpMRI alone shows better diagnostic accuracy for extraprostatic invasion.关键词
前列腺癌/18F-DCFPyL PET/CT/多参数磁共振/前列腺包膜外侵犯/盆腔淋巴结转移Key words
prostate cancer/18F-DCFPyL PET/CT/multiparametric magnetic resonance/extraprostatic extension/pelvic lymph node metastasis分类
医药卫生
