肿瘤预防与治疗2025，Vol.38Issue(3)：201-209,9.DOI:10.3969/j.issn.1674-0904.2025.03.004
18F-PSMA-1007 PET/CT与mpMRI在前列腺癌局部分期的诊断效能比较
Comparison of Diagnostic Performance between 18F-PSMA-1007 PET/CT and mpMRI in Local Staging of Prostate Cancer
摘要
Abstract
Objective:To compare the efficacy of 18F-prostate-specific membrane antigen(PSMA)-1007 PET/CT and multiparametric magnetic resonance imaging(mpMRI)in the local staging of prostate cancer(PCa),and to clarify the clini-cal application value of 18F-PSMA-1007.Methods:A retrospective analysis was conducted on clinical data from patients di-agnosed with PCa via prostate biopsy at Sichuan Cancer Hospital between November 2018 and January 2023.All patients un-derwent radical prostatectomy(RP)with extended pelvic lymph node dissection(ePLND),and preoperative 18F-PSMA-1007 PET/CT and mpMRI examinations were completed for each patient.Using postoperative histopathological results as the gold standard,the diagnostic performance of 18F-PSMA-1007 PET/CT and mpMRI was compared for detecting extracapsular extension(ECE),seminal vesicle invasion(SVI),and pelvic lymph node metastases(LNM)in PCa.The sensitivity,spe-cificity,positive predictive value,negative predictive value,and accuracy of the two methods were calculated.Additionally,the agreement between the two imaging modalities and the gold standard was analyzed using the Kappa test.Results:A total of 41 patients were included,with a mean age of(68.5±6.1)years.The median serum PSA level was 35.5(range:15.9～85.2)ng/mL,with 4 cases having PSA＜10 ng/mL,8 cases with PSA 10～20 ng/mL,20 cases with PSA 20～100 ng/mL,and 9 cases with PSA＞100 ng/mL.According to the International Society of Urological Pathology grading system,the cases were distributed as follows:Grade Group 1(3 cases),Grade Group 2(6 cases),Grade Group 3(7 cases),Grade Group 4(10 cases),and Grade Group 5(15 cases).Thirty-five patients underwent laparoscopic radical prostatectomy with ePLND,while 6 patients underwent robot-assisted radical prostatectomy with ePLND.Based on the D'Amico risk classifica-tion,39 patients(95.1％)were classified as high-risk,2 patients(4.9％)as intermediate-risk,and none as low-risk.Postoperative pathology confirmed ECE in 21 cases,SVI in 7 cases,and pelvic LNM in 15 cases.In the detection of ECE,both 18F-PSMA-1007 PET/CT and mpMRI identified 8 cases,with 2 false positives and 13 missed diagnoses,demonstrating similar diagnostic performance.The sensitivity was 38.1％,specificity was 90.0％,accuracy was 63.4％,and the Kappa value was 0.277.For the detection of SVI,both imaging modalities identified 4 true-positive cases,with a sensitivity of 57.1％(4/7).18F-PSMA-1007 PET/CT demonstrated higher specificity(88.2％vs 85.3％)and accuracy(82.9％vs 80.5％)compared to mpMRI,although these differences were not statistically significant(P＞0.05).For the detection of pelvic LNM,18F-PSMA-1007 PET/CT demonstrated significantly higher diagnostic sensitivity(93.3％)compared to mpMRI(53.3％),with a statistically significant difference(P＜0.05).The agreement between 18F-PSMA-1007 PET/CT and histo-pathology was significantly higher than that between mpMRI and histopathology(Kappa value:0.796 vs 0.443).Conclu-sion:18F-PSMA-1007 PET/CT demonstrates higher sensitivity and better agreement with the gold standard in detecting pel-vic LNM in PCa compared to mpMRI,while both imaging modalities show similar diagnostic performance for ECE and SVI.These findings provide valuable guidance for clinicians in selecting the appropriate imaging technique for the diagnosis and staging of prostate cancer.关键词
前列腺癌/前列腺特异性膜抗原/正电子发射断层显像术/多参数磁共振成像/诊断效能Key words
Prostate cancer/Prostate-specific membrane antigen/Positron emission tomography/Multiparametric magnet-ic resonance imaging/Diagnostic efficacy分类
医药卫生引用本文复制引用
刘骏锋,李曾,周术奎,陈勇吉,沈镇岗,李云龙,杨盛柯,廖洪..18F-PSMA-1007 PET/CT与mpMRI在前列腺癌局部分期的诊断效能比较[J].肿瘤预防与治疗,2025,38(3):201-209,9.基金项目
四川省科技厅重点研发项目(编号:2020YFS0421) （编号:2020YFS0421）
四川省卫生健康委员会医学科技项目(编号:23LCYJ004) This study was supported by grants from Science and Technology Department of Sichuan Province(No.2020YFS0421)and Health Commission of Sichuan Province(No.23LCYJ004). （编号:23LCYJ004）
