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Phelps TE, Harmon SA, Mena E, Lindenberg L, Shih JH, Citrin DE, Pinto PA, Wood BJ, Dahut WL, Gulley JL, Madan RA, Choyke PL, Turkbey B. Predicting Outcomes of Indeterminate Bone Lesions on 18F-DCFPyL PSMA PET/CT Scans in the Setting of High-Risk Primary or Recurrent Prostate Cancer. J Nucl Med 2023; 64:395-401. [PMID: 36265908 DOI: 10.2967/jnumed.122.264334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Indeterminate bone lesions (IBLs) on prostate-specific membrane antigen (PSMA) PET/CT are common. This study aimed to define variables that predict whether such lesions are likely malignant or benign using features on PSMA PET/CT. Methods: 18F-DCFPyL PET/CT imaging was performed on 243 consecutive patients with high-risk primary or biochemically recurrent prostate cancer. IBLs identified on PSMA PET/CT could not definitively be interpreted as benign or malignant. Medical records of patients with IBLs were reviewed to determine the ultimate status of each lesion. IBLs were deemed malignant or benign on the basis of evidence of progression or stability at follow-up, respectively, or by biopsy results; IBLs were deemed equivocal when insufficient or unclear evidence existed. Post hoc patient, lesion, and scan variables accounting for clustered data were evaluated using Wilcoxon rank-sum and χ2 tests to determine features that favored benign or malignant interpretation. Results: Overall, 98 IBLs within 267 bone lesions (36.7%) were identified in 48 of 243 patients (19.8%). Thirty-seven of 98 IBLs were deemed benign, and 42 were deemed malignant, of which 8 had histologic verification; 19 remained equivocal. Location and SUVmax categorical variables were predictive of IBL interpretation (P = 0.0201 and P = 0.0230, respectively). For IBLs with new interpretations, 34 of 37 (91.9%) considered benign showed an SUVmax of less than 5 or exhibited focal uptake without coexisting bone metastases; 37 of 42 (88.1%) deemed malignant demonstrated an SUVmax of at least 5 or were present with coexisting bone metastases. Logistic regression predicted IBLs with a high SUVmax (univariable: odds ratio [OR], 9.29 [P = 0.0016]; multivariable: OR, 13.87 [P = 0.0089]) or present with other bone metastases (univariable: OR, 9.87 [P = 0.0112]; multivariable: OR, 11.35 [P = 0.003]) to be malignant. Conclusion: IBLs on PSMA PET/CT are concerning; however, characterizing their location, SUV, and additional scan findings can aid interpretation. IBLs displaying an SUVmax of at least 5 or present with other bone metastases favor malignancy. IBLs without accompanying bone metastases that exhibit an SUVmax of less than 5 and are observed only in atypical locations favor benign processes. These guidelines may assist in the interpretation of IBLs on PSMA PET/CT.
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Affiliation(s)
- Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland;
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Esther Mena
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Joanna H Shih
- Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland.,Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and
| | - William L Dahut
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - James L Gulley
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ravi A Madan
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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