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Lv Z, Song L, Wang M, Hou H, Li H, Wang X, Wang J, Wang J, Liu M. 18 F-prostate specific membrane antigen positron emission tomography/computerized tomography for lymph node staging in medium/high risk prostate cancer: A systematic review and meta-analysis. Chin Med J (Engl) 2024; 137:949-958. [PMID: 37690993 PMCID: PMC11046020 DOI: 10.1097/cm9.0000000000002850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Lymph node staging of prostate cancer (PCa) is important for planning and monitoring of treatment. 18 F-prostate specific membrane antigen positron emission tomography/computerized tomography ( 18 F-PSMA PET/CT) has several advantages over 68 Ga-PSMA PET/CT, but its diagnostic value requires further investigation. This meta-analysis focused on establishing the diagnostic utility of 18 F-PSMA PET/CT for lymph node staging in medium/high-risk PCa. METHODS We searched the EMBASE, PubMed, Cochrane library, and Web of Science databases from inception to October 1, 2022. Prostate cancer, 18 F, lymph node, PSMA, and PET/CT were used as search terms and the language was limited to English. We additionally performed a manual search using the reference lists of key articles. Patients and study characteristics were extracted and the QUADAS-2 tool was employed to evaluate the quality of included studies. Sensitivity, specificity, the positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), area under the curve (AUC), and 95% confidence interval (CI) were used to evaluate the diagnostic value of 18 F-PSMA PET/CT. Stata 17 software was employed for calculation and statistical analyses. RESULTS A total of eight diagnostic tests including 734 individual samples and 6346 lymph nodes were included in this meta-analysis. At the patient level, the results of each consolidated summary were as follows: sensitivity of 0.57 (95% CI 0.39-0.73), specificity of 0.95 (95% CI 0.92-0.97), PLR of 11.2 (95% CI 6.6-19.0), NLR of 0.46 (95% CI 0.31-0.68), DOR of 25 (95% CI 11-54), and AUC of 0.94 (95% CI 0.92-0.96). At the lesion level, the results of each consolidated summary were as follows: sensitivity of 0.40 (95% CI 0.21-0.62), specificity of 0.99 (95% CI 0.95-1.00), PLR of 40.0 (95% CI 9.1-176.3), NLR of 0.61 (95% CI 0.42-0.87), DOR of 66 (95% CI 14-311), and AUC of 0.86 (95% CI 0.83-0.89). CONCLUSIONS 18 F-PSMA PET/CT showed moderate sensitivity but high specificity in lymph node staging of medium/high-risk PCa. The diagnostic efficacy was almost equivalent to that reported for 68 Ga-PSMA PET/CT. REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO), No. CRD42023391101.
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Affiliation(s)
- Zhengtong Lv
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Liuqi Song
- Peking University Fifth School of Clinical Medicine, Beijing 100730, China
| | - Miao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Huimin Hou
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Haodong Li
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jianlong Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
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Ma W, Chen B, Zhu F, Yang C, Yang J. Diagnostic role of F-18 FDG PET/CT in determining preoperative Lymph node status of patients with rectal cancer: a meta-analysis. Abdom Radiol (NY) 2024:10.1007/s00261-023-04140-4. [PMID: 38281158 DOI: 10.1007/s00261-023-04140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE To obtain performance values of PET/CT for determining the nodal status of rectal cancer. MATERIALS A comprehensive literature search was performed on PubMed and Embase for original diagnostic accuracy studies on the diagnostic performance of PET-CT for detection of LN metastasis in rectal cancer. The QUADAS-2 was used to evaluate the methodological quality of each study. Pooled sensitivity, specificity, and AUC were calculated to estimate the diagnostic role of PET/CT using a random-effects model. A subgroup analysis was performed to investigate the influence of different parameters on diagnostic performance. RESULTS A total of 15 studies and 1209 patients were included. A publication bias was observed. The pooled sensitivity, specificity, and AUC for PET/CT was 0.62 (95% CI 0.49, 0.74), 0.94 (95% CI 0.87, 0.97), and 0.87 (95% CI 0.83-0.89), respectively. Per-node basis yields higher accuracy than per-patient basis, with pooled sensitivities of 0.65 (95% CI 0.50-0.79) vs. 0.56 (95% CI 0.36-0.77) and specificities of 0.96 (95% CI 0.92-1.00) vs. 0.88 (95% CI 0.76-1.00), but there were no significant differences in diagnostic accuracy. CONCLUSION PET/CT has high specificity but moderate sensitivity for the detection of LN metastasis in rectal cancer. The current data suggests that the diagnostic capabilities of this method is limited due to its moderate sensitivity.
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Affiliation(s)
- Weili Ma
- Department of Radiology, Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment of Shaoxing City, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Bo Chen
- Department of Radiology, Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment of Shaoxing City, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Fandong Zhu
- Department of Radiology, Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment of Shaoxing City, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Chen Yang
- Department of Radiology, Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment of Shaoxing City, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Jianfeng Yang
- Department of Radiology, Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment of Shaoxing City, Shaoxing People's Hospital, Shaoxing, 312000, China.
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Rousseau C, Le Thiec M, Maucherat B, Frindel M, Fleury V. [Place of molecular imaging in the management of prostate cancer]. Cancer Radiother 2021; 25:663-666. [PMID: 34404605 DOI: 10.1016/j.canrad.2021.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/19/2022]
Abstract
In the management of prostate cancer in recent years, innovative therapies have appeared requiring precise and reliable disease detection. In 2021, new generation imaging (PET/CT, multiparametric MRI, PET/MRI) have their place at all stages of the prostate cancer natural history to help target the lesion(s) and guide therapy and improve the results obtained. PSMA PET/CT is currently the leader in this type of imaging with a complete offer during the disease: both from diagnosis, to recurrence or in the oligo-metastatic and metastatic stage resistant to castration with a pivotal role in the PSMA theranostic approach. However, multiparametric MRI also has many detection advantages when the prostate is left in place, which suggests the potential major benefit of hybrid PSMA PET/MRI imaging.
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Affiliation(s)
- C Rousseau
- Département de médecine nucléaire, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France; Université de Nantes, 44000 Nantes, France; Inserm, CNRS, CRCINA, 44000 Nantes, France.
| | - M Le Thiec
- Département de médecine nucléaire, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France
| | - B Maucherat
- Département de médecine nucléaire, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France
| | - M Frindel
- Département de pharmacie, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France
| | - V Fleury
- Département de médecine nucléaire, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France
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Diagnostic Performance of PET Imaging Using Different Radiopharmaceuticals in Prostate Cancer According to Published Meta-Analyses. Cancers (Basel) 2020; 12:cancers12082153. [PMID: 32759672 PMCID: PMC7463824 DOI: 10.3390/cancers12082153] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023] Open
Abstract
A significant number of meta-analyses reporting data on the diagnostic performance of positron emission tomography (PET) in prostate cancer (PCa) is currently available in the literature. In particular, different PET radiopharmaceuticals were used for this purpose. The aim of this review is to summarize information retrieved by published meta-analyses on this topic. The first step included a systematic search of the literature (last search date: June 2020), screening two databases (PubMed/MEDLINE and Cochrane Library). This combination of key words was used: (A) “PET” OR “positron emission tomography” AND (B) “prostate” OR “prostatic” AND (C) meta-analysis. Only meta-analyses on Positron Emission Tomography/Computed Tomography (PET/CT) or Positron Emission Tomography/Magnetic Resonance (PET/MR) in PCa were selected. We have summarized the diagnostic performance of PET imaging in PCa, taking into account 39 meta-analyses published in the literature. Evidence-based data showed the good diagnostic performance of PET/CT with several radiopharmaceuticals, including prostate-specific membrane antigen (PSMA)-targeted agents, radiolabeled choline, fluciclovine, and fluoride in restaging and staging settings. Less evidence-based data were available for PET/MR with different radiotracers. More prospective multicentric studies and cost-effectiveness analyses are warranted.
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Is 18F-FDG PET/CT an Accurate Way to Detect Lymph Node Metastasis in Colorectal Cancer: A Systematic Review and Meta-Analysis. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:5439378. [PMID: 32733174 PMCID: PMC7383332 DOI: 10.1155/2020/5439378] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022]
Abstract
Aims The purpose of this study was to assess the diagnostic value of 18F-fluorodeoxy-glucose positron emission tomography/computed tomography (FDG PET/CT) for detection of lymph node (LN) metastasis of colorectal cancer. Material and Methods. A computerized search was performed to determine the relevant articles, published before October 2019. Stata Statistical Software, version 15.0, and Meta-Disc (version 1.4) were used for the meta-analysis. Results the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 0.65, 0.75, 4.57, and 0.37 respectively. Studies that used SUVmax cut-off value (≤2.5) demonstrated the best accuracy. Conclusion 18F-FDG PET/CT shows a low sensitivity and high specificity for detecting the metastasis of LNs in patients with newly diagnosed colorectal cancer.
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Henkenberens C, Oehus AK, Derlin T, Bengel F, Ross TL, Kuczyk MA, Janssen S, Christiansen H, von Klot CAJ. Efficacy of repeated PSMA PET-directed radiotherapy for oligorecurrent prostate cancer after initial curative therapy. Strahlenther Onkol 2020; 196:1006-1017. [PMID: 32399639 PMCID: PMC7581615 DOI: 10.1007/s00066-020-01629-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/25/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess the outcome of prostate cancer (PCa) patients diagnosed with oligorecurrent disease and treated with a first and a second PSMA (prostate-specific membrane antigen ligand) PET(positron-emission tomography)-directed radiotherapy (RT). PATIENTS AND METHODS Thirty-two patients with oligorecurrent relapse after curative therapy received a first PSMA PET-directed RT of all metastases. After biochemical progression, all patients received a second PSMA PET-directed RT of all metastases. The main outcome parameters were biochemical progression-free survival (bPFS) and androgen deprivation therapy-free survival (ADT-FS). The intervals of BPFS were analyzed separately as follows: the interval from the last day of PSMA PET-directed RT to the first biochemical progression was defined as bPFS_1 and the interval from second PSMA PET-directed RT to further biochemical progression was defined as bPFS_2. RESULTS The median follow-up duration was 39.5 months (18-60). One out of 32 (3.1%) patients died after 47 months of progressive metastatic prostate cancer (mPCa). All patients showed biochemical responses after the first PSMA PET-directed RT and the median prostate-specific antigen (PSA) level before RT was 1.70 ng/mL (0.2-3.8), which decreased significantly to a median PSA nadir level of 0.39 ng/mL (range <0.07-3.8; p = 0.004). The median PSA level at biochemical progression after the first PSMA PET-directed RT was 2.9 ng/mL (range 0.12-12.80; p = 0.24). Furthermore, the PSA level after the second PSMA PET-directed RT at the last follow-up (0.52 ng/mL, range <0.07-154.0) was not significantly different (p = 0.36) from the median PSA level (1.70 ng/mL, range 0.2-3.8) before the first PSMA PET-directed RT. The median bPFS_1 was 16.0 months after the first PSMA PET-directed RT (95% CI 11.9-19.2) and the median bPFS_2 was significantly shorter at 8.0 months (95% CI 6.3-17.7) after the second PSMA PET-directed RT (p = 0.03; 95% CI 1.9-8.3). Multivariate analysis revealed no significant parameter for bPFS_1, whereas extrapelvic disease was the only significant parameter (p = 0.02, OR 2.3; 95% CI 0.81-4.19) in multivariate analysis for bPFS_2. The median ADT-FS was 31.0 months (95% CI 20.1-41.8) and multivariate analysis showed that patients with bone metastases, compared to patients with only lymph node metastases at first PSMA PET-directed RT, had a significantly higher chance (p = 0.007, OR 4.51; 95% CI 1.8-13.47) of needing ADT at the last follow-up visit. CONCLUSION If patients are followed up closely, including PSMA PET scans, a second PSMA PET-directed RT represents a viable treatment option for well-informed and well-selected patients.
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Affiliation(s)
- Christoph Henkenberens
- Department of Radiotherapy and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Ann-Kathrin Oehus
- Department of Radiotherapy and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank Bengel
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Tobias L Ross
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefan Janssen
- Medical practice for Radiotherapy and Radiation Oncology, Treibesstraße 11, 31134, Hildesheim, Germany.,Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Hans Christiansen
- Department of Radiotherapy and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christoph A J von Klot
- Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Peabody H, Lane BR, Qi J, Kim T, Montie JE, Moriarity A, Brede CM, Montgomery J. Limitations of abdominopelvic CT and multiparametric MR imaging for detection of lymph node metastases prior to radical prostatectomy. World J Urol 2020; 39:779-785. [PMID: 32361876 DOI: 10.1007/s00345-020-03227-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/24/2020] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To investigate the performance of pre-surgery CT and multiparametric MRI (mpMRI) to identify lymph node (LN) metastases in the Michigan Urological Surgery Improvement Collaborative (MUSIC). Abdominopelvic CT and mpMRI are commonly used for intermediate- and high-risk prostate cancer (PCa) staging. METHODS Retrospective analysis of the MUSIC registry identified patients undergoing robot-assisted radical prostatectomy (RP) between 3/2012 and 7/2018. Patients were classified according to pre-surgery imaging modality. Primary outcomes were operating characteristics of CT and mpMRI for detection of pathologic LN involvement (pN1). RESULTS A total of 10,250 patients underwent RP and 3924 patients (38.3%) underwent CT and/or mpMRI prior to surgery. Suspicion for LN involvement was identified on 2.3% CT and 1.9% mpMRI. Overall, 391 patients were pN1(3.8%), including 0.1% low-, 2.1% intermediate-, and 10.9% high-risk PCa patients. Of 235 pN1 patients that underwent CT prior, far more had negative (91.1%) than positive (8.9%) findings, yielding sensitivity: 8.9%, specificity: 98.3%, negative predictive value (NPV): 92.1%, and positive predictive value (PPV): 32.3% for CT with regard to LN metastases. Similarly, more patients with pN1 disease had negative mpMRI (81.0%) then suspicious or indeterminate MRI (19.0%), yielding sensitivity: 19.0%, specificity: 97.3%, NPV: 95.9%, and PPV: 26.7%. CONCLUSIONS Abdominopelvic CT and mpMRI have clear limitations in identifying LN metastases. Additional clinicopathologic features should be considered when making management decisions, as 2.1% and 10.9% with intermediate-and high-risk cancer had metastatic LNs. The majority of pN1 patients had a negative CT or a negative/indeterminate mpMRI prior to RP. Pelvic LN dissection should be performed in RP patients with intermediate- or high-risk PCa, independent of preoperative imaging results.
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Affiliation(s)
- Henry Peabody
- Spectrum Health, 145 Michigan Street NE, Grand Rapids, MI, USA
| | - Brian R Lane
- Spectrum Health, 145 Michigan Street NE, Grand Rapids, MI, USA.
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| | - Ji Qi
- Michigan Medicine, Ann Arbor, MI, USA
| | - Tae Kim
- Michigan Medicine, Ann Arbor, MI, USA
| | | | - Andrew Moriarity
- Spectrum Health, 145 Michigan Street NE, Grand Rapids, MI, USA
- Advanced Radiology Services, PC, Grand Rapids, MI, USA
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