Head-to-Head Comparison of 68 Ga-PSMA-11 PET/CT and mpMRI with a Histopathology Gold Standard in the Detection, Intraprostatic Localization, and Determination of Local Extension of Primary Prostate Cancer: Results from a Prospective Single-Center Imaging Trial

The Journal of Nuclear Medicine

article

Ida Sonni¹  Ely R. Felker²  Andrew T. Lenis³  Anthony E. Sisk⁴  Shadfar Bahri¹  Martin Allen-Auerbach¹  Wesley R. Armstrong¹  Voraparee Suvannarerg²  Teeravut Tubtawee²  Tristan Grogan⁵  David Elashoff⁵  Matthias Eiber¹  Steven S. Raman²  Johannes Czernin¹  Robert E. Reiter³  Jeremie Calais¹ 

[1] Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA;Department of Radiology, David Geffen School of Medicine, UCLA;Department of Urology, UCLA;Department of Pathology, David Geffen School of Medicine, UCLA;Department of Medicine Statistics Core, UCLA;Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich;Institute of Urologic Oncology, David Geffen School of Medicine, UCLA;Jonsson Comprehensive Cancer Center, UCLA

关键词: PSMA PET/CT;    prostate cancer;    mpMRI;    staging;    T staging;   

DOI  :  10.2967/jnumed.121.262398

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

The role of prostate-specific membrane antigen (PSMA)–targeted PET in comparison to multiparametric MRI (mpMRI) in the evaluation of intraprostatic cancer foci is not well defined. The aim of our study was to compare the diagnostic performance of 68Ga-PSMA-11 PET/CT (PSMA PET/CT), mpMRI, and PSMA PET/CT + mpMRI using 3 independent masked readers for each modality and with histopathology as the gold standard in the detection, intraprostatic localization, and determination of local extension of primary prostate cancer. Methods: Patients with intermediate- or high-risk prostate cancer who underwent PSMA PET/CT as part of a prospective trial (NCT03368547) and mpMRI before radical prostatectomy were included. Each imaging modality was interpreted by 3 independent readers who were unaware of the other modality result. A central majority rule was applied (2:1). Pathologic examination of whole-mount slices was used as the gold standard. Imaging scans and whole-mount slices were interpreted using the same standardized approach on a segment level and a lesion level. A “neighboring” approach was used to define imaging–pathology correlation for the detection of individual prostate cancer foci. Accuracy in determining the location, extraprostatic extension (EPE), and seminal vesicle invasion (SVI) of prostate cancer foci was assessed using receiver-operating-characteristic curve analysis. Interreader agreement was calculated using intraclass correlation coefficient analysis. Results: The final analysis included 74 patients (14 [19%] with intermediate risk and 60 [81%] with high risk). The cancer detection rate (lesion-based analysis) was 85%, 83%, and 87% for PSMA PET/CT, mpMRI, and PSMA PET/CT + mpMRI, respectively. The change in AUC was statistically significant between PSMA PET/CT + mpMRI and the 2 imaging modalities alone for delineation of tumor localization (segment-based analysis) (P < 0.001) but not between PSMA PET/CT and mpMRI (P = 0.093). mpMRI outperformed PSMA PET/CT in detecting EPE (P = 0.002) and SVI (P = 0.001). In the segment-level analysis, intraclass correlation coefficient analysis showed moderate reliability among PSMA PET/CT and mpMRI readers using a 5-point Likert scale (range, 0.53–0.64). In the evaluation of T staging, poor reliability was found among PSMA PET/CT readers and poor to moderate reliability was found for mpMRI readers. Conclusion: PSMA PET/CT and mpMRI have similar accuracy in the detection and intraprostatic localization of prostate cancer foci. mpMRI performs better in identifying EPE and SVI. For the T-staging evaluation of intermediate to high-risk prostate cancer, mpMRI should still be considered the imaging modality of reference. Whenever available, PSMA PET/MRI or the coregistration or fusion of PSMA PET/CT and mpMRI (PSMA PET/CT + mpMRI) should be used as it improves tumor extent delineation.

【 授权许可】

CC BY