摘要
目的比较^(18)F-前列腺特异性膜抗原(PSMA)-1007 PET/CT与多参数磁共振(mpMRI)对前列腺癌盆腔淋巴结转移的诊断效能。方法回顾性分析20^(18)年11月至2021年4月于四川省肿瘤医院同期行^(18)F-PSMA-1007 PET/CT和mpMRI检查的30例前列腺癌患者的临床病理资料。年龄(68.4±6.4)岁,术前血清总前列腺特异性抗原45.70(16.07,100.00)ng/ml。30例中14例PET/CT淋巴结阳性,7例mpMRI淋巴结阳性。术前临床T分期:T1期1例,T2期20例,T3期6例,T4期3例;危险度分层高危29例,中危1例。30例均行腹腔镜根治性前列腺切除术+盆腔扩大淋巴结清扫术。根据术后淋巴结病理检查结果,分析两种影像学检查诊断前列腺癌盆腔淋巴结转移的敏感性、特异性、阳性预测值和阴性预测值,同时采用Kappa检验分析两种影像学检查与术后淋巴结病理结果的一致性。结果本组30例术后病理均为前列腺癌,其中10例盆腔淋巴结阳性。以术后病理作为诊断金标准,按照盆腔淋巴结转移例数计算诊断效能,^(18)F-PSMA-1007 PET/CT的敏感性、特异性、阳性预测值、阴性预测值分别为100.0%(10/10)、80.0%(16/20)、71.4%(10/14)、100.0%(16/16),Kappa值为0.727;mpMRI诊断盆腔淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值分别为70.0%(7/10)、100.0%(20/20)、100.0%(7/7)、87.0%(20/23),Kappa值为0.757;两种方法的敏感性、特异性、阳性预测值、阴性预测值比较,P值分别为0.^(18)、0.07、0.30、<0.01。按盆腔淋巴结转移个数计算诊断效能,^(18)F-PSMA-1007 PET/CT的敏感性、特异性、阳性预测值、阴性预测值分别为100.0%(28/28)、98.2%(373/380)、80.0%(28/35)、100.0%(373/373);mpMRI的敏感性、特异性、阳性预测值、阴性预测值分别为78.6%(22/28)、100.0%(380/380)、100.0%(22/22)、98.4%(380/386);两种方法的敏感性、特异性、阳性预测值、阴性预测值比较,差异均有统计学意义(均P<0.01)。结论^(18)F-PSMA-1007 PET/CT诊断淋巴结转移的敏感性和阴性预测值均高于mpMRI,mpMRI诊断的特异性和阳性预测值高于^(18)F-PSMA-1007 PET/CT。
Objective To compare the diagnostic efficacy of^(18)F-prostate specific membrane antigen(PSMA)-1007 PET/CT and mpMRI in the diagnosis of pelvic lymph node metastasis of prostate cancer(PCa).Methods The clinical data of 30 patients who underwent^(18)F-PSMA-1007 PET/CT and mpMRI examinations in Sichuan Cancer Hospital from November 20^(18)to April 2021 were analyzed.The average age was(68.4±6.4)years old.The preoperative total PSA was 45.70(16.07,100.00)ng/ml.Among 30 patients,14 cases were found lymph node positive by PET/CT and 7 cases were found lymph node positive by mpMRI.Combined with the two preoperative imaging methods and the patient's PSA level,there was 1 patient in stage T1,20 patients in stage T2,6 patients in stage T3,and 3 patients in stage T4.Twenty-nine cases were classified as high risk group and one case was in moderate risk group.All 30 patients underwent laparoscopic radical prostatectomy and enlarged pelvic lymph node dissection(ePLND).According to the postoperative pathological results,the sensitivity,specificity,positive predictive value and negative predictive value of the two imaging techniques for the diagnosis of PCa pelvic lymph node metastasis were calculated,and the consistency of the two imaging techniques for the postoperative pathological results was observed by Kappa test.Results All the 30 patients were confirmed to be PCa by postoperative pathology,among which 10 patients were positive for pelvic lymph node biopsy.The sensitivity,specificity,positive predictive value and negative predictive value of^(18)F-PSMA-1007 PET/CT for pelvic lymph node metastasis were 100.0%(10/10),80.0%(16/20),71.4%(10/14)and 100.0%(16/16)respectively,and Kappa value was 0.727.The sensitivity and specificity of mpMRI were 70.0%(7/10)and 100.0%(20/20),the positive and negative predictive values were 100.0%(7/7)and 87.0%(20/23)respectively,and the Kappa value was 0.757.The P values of sensitivity,specificity,positive predictive value and negative predictive value between the two imaging methods were 0.^(18),0.07,0.30,<0.01,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of^(18)F-PSMA-1007 PET/CT in diagnosing the number of pelvic lymph node metastasis were 100%(28/28),98.2%(373/380),80.0%(28/35)and 100.0%(373/373),respectively.The sensitivity,specificity,positive predictive value and negative predictive value of mpMRI in diagnosing the number of pelvic lymph node metastasis were 78.6%(22/28),100.0%(380/380),100.0%(22/22)and 98.4%(380/386),respectively.The P values of the sensitivity,specificity,positive predictive value and negative predictive value of lymph node detection by the two imaging methods were all<0.01,and the differences were statistically significant.Conclusions The sensitivity and negative predictive value of^(18)F-PSMA-1007 PET/CT for the detection of positive lymph node were higher than mpMRI.The specificity and positive predictive value of mpMRI in detecting positive lymph node metastasis were higher than^(18)F-PSMA-1007 PET/CT examination.
作者
刘磊
周术奎
张桂银
唐多才
李曾
杨盛柯
陈勇吉
张芳
廖洪
Liu Lei;Zhou Shukui;Zhang Guiyin;Tang Duocai;Li Zeng;Yang Shengke;Chen Yongji;Zhang Fang;Liao Hong(Department of Urology,The Affiliated Cancer Hospital,School of Medicine,University of Electronic Science and Technology of China,Institute of Sichuan Cancer Hospital,Sichuan Cancer Prevention Center,Chengdu 610057,China;epartment of Pathology,The Affiliated Cancer Hospital,School of Medicine,University of Electronic Science and Technology of China,Institute of Sichuan Cancer Hospital,Sichuan Cancer Prevention Center,Chengdu.610057,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2022年第1期40-45,共6页
Chinese Journal of Urology
基金
四川省卫生和计划生育委员会重点研究项目(19ZD015)
四川省医学青年创新科研课题计划(Q19065)
四川省科技计划项目(2020YFS0421)。
关键词
前列腺肿瘤
癌
前列腺特异性膜抗原
正电子发射断层显像术
盆腔淋巴结转移
多参数磁共振成像
Prostatic neoplasms
Carcinoma
Prostate specific membrane antigen
Positron emission tomography
Pelvic lymph node metastasis
Multi-parameter magnetic resonance imaging
