^(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

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.