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. Petersen, 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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalWorld journal of urology
DOIs
StatePublished - Jan 1 2019

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Diffusion Magnetic Resonance Imaging
Routine Diagnostic Tests
Prostatic Neoplasms
Radiotherapy
Lymph Nodes
Neoplasm Metastasis
Lymph Node Excision
Sensitivity and Specificity

Keywords

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

ASJC Scopus subject areas

  • Urology

Cite this

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. / Petersen, Lars J.; Nielsen, Julie B.; Langkilde, Niels C.; Petersen, Astrid; Afshar-Oromieh, Ali; De Souza, Nandita M.; De Paepe, Katja; Fisker, Rune V.; Arp, Dennis T.; Carl, Jesper; Haberkorn, Uwe; Zacho, Helle D.

In: World journal of urology, 01.01.2019.

Research output: Contribution to journalArticle

Petersen, Lars J. ; Nielsen, Julie B. ; Langkilde, Niels C. ; Petersen, Astrid ; Afshar-Oromieh, Ali ; De Souza, Nandita M. ; De Paepe, Katja ; Fisker, Rune V. ; Arp, Dennis T. ; Carl, Jesper ; Haberkorn, Uwe ; Zacho, Helle D. / 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. In: World journal of urology. 2019.
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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",
author = "Petersen, {Lars J.} and Nielsen, {Julie B.} and Langkilde, {Niels C.} and Astrid Petersen and Ali Afshar-Oromieh and {De Souza}, {Nandita M.} and {De Paepe}, Katja and Fisker, {Rune V.} and Arp, {Dennis T.} and Jesper Carl and Uwe Haberkorn and Zacho, {Helle D.}",
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T1 - 68Ga-PSMA PET/CT compared with MRI/CT and diffusion-weighted MRI for primary lymph node staging prior to definitive radiotherapy in prostate cancer

T2 - a prospective diagnostic test accuracy study

AU - Petersen, Lars J.

AU - Nielsen, Julie B.

AU - Langkilde, Niels C.

AU - Petersen, Astrid

AU - Afshar-Oromieh, Ali

AU - De Souza, Nandita M.

AU - De Paepe, Katja

AU - Fisker, Rune V.

AU - Arp, Dennis T.

AU - Carl, Jesper

AU - Haberkorn, Uwe

AU - Zacho, Helle D.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Anatomical cross-sectional imaging

KW - Diagnostic accuracy

KW - Prostatic neoplasm

KW - PSMA PET/CT

KW - Staging

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