^(68)Ga-PSMA,PET/CT显像在前列腺重复穿刺前对良恶性病变的预判价值

The predictive value of 68Ga-PSMA PET/CT to distinguish between benign and malignant prostate disease before repeat prostate biopsy

目的探讨前列腺重复穿刺前行^(68)Ga-PSMA PET/CT显像对前列腺良恶性病变的预判价值。方法回顾性分析2017年2月至2019年3月北京大学肿瘤医院收治的39例行前列腺重复穿刺患者的临床资料和影像数据。中位年龄65(46~81)岁。既往穿刺次数中位值1(1~3)次。总前列腺特异性抗原(PSA)中位值11.00(5.41~49.78)ng/ml;f/tPSA中位值0.15(0.01~16.50)ng/ml;前列腺体积中位值43.80(7.79~108.63)ml;PSA密度中位值0.24(0.09~2.31)ng/ml2。所有患者穿刺前行^(68)Ga-PSMA PET/CT检查,然后行经直肠超声引导下前列腺系统性穿刺。根据穿刺病理结果,对患者的^(68)Ga-PSMA PET/CT图像进行视觉及半定量分析。视觉分析根据^(68)Ga-PSMA在前列腺中的摄取特征分为单灶型、多灶型和不均匀型等亚组,分析不同亚组的前列腺癌检出率。绘制受试者工作特征(ROC)曲线,分析^(68)Ga-PSMA PET/CT半定量指标肿瘤最大摄取值(SUV_(max))和肿瘤与正常前列腺本底的摄取比值(SUVT/BGp)对前列腺癌的诊断效能。结果经前列腺穿刺活检病理诊断前列腺癌18例(46.2%),其中12例为临床有意义前列腺癌。影像特征为单灶型、多灶型、不均匀型者分别为12、7、20例,其检出前列腺癌分别为11、5、2例。ROC曲线分析结果显示,SUV_(max)截断值为5.3时,^(68)Ga-PSMA PET/CT判断前列腺良恶性病变的敏感性和特异性分别为100.0%和85.7%,曲线下面积(AUC)为0.979;SUVT/BGp截断值为1.8时,判断敏感性和特异性分别为83.3%和90.5%,AUC为0.915。结论重复穿刺前行^(68)Ga-PSMA PET/CT显像有助于预判前列腺病灶的良恶性及检出前列腺癌病灶。

Objective To investigate the diagnostic performance of repeat biopsy ^(68)Ga-PSMA PET/CT to distinguish between benign and malignant prostate disease.Methods The clinical data and medical imaging of thirty-nine patients underwent repeat prostate biopsy were analyzed respectively in this study.The median age of patients was 65 years(range 46-81 years),the median PSA level was 11.0ng/ml(range 5.4-49.8 ng/ml),f/tPSA was 0.15(0.01-16.50)ng/ml,prostate volume was 43.80(7.79-108.63)ml,and PSA density was 0.24(0.09-2.31)ng/ml2.All patients underwent pre-biopsy ^(68)Ga-PSMA PET/CT and the standard transrectal ultrasound-guided systematic prostate biopsy.Based on the biopsy results,^(68)Ga-PSMA PET/CT images of all patients were visually and semi-quantitatively analyzed.By visual analysis,^(68)Ga-PSMA uptake in prostate was defined as focal,multimodal and inhomogeneous,and then the detection rate of prostate cancer in each subgroup was analyzed.The value of the ROC curve in the diagnosis of prostate cancer was analyzed based on the SUV_(max) of prostate cancer(SUV_(max)),tumor-to-normal-prostate background(SUVT/BGp)as semi-quantitative parameters of ^(68)Ga-PSMA PET/CT.Results Prostate cancer was detected in 18 patients(46.2%)and 12 patients(30.8%)had clinically significant disease.There were 11,5 and 2 patients with prostate cancer respectively in men with a focal(12 patients),multifocal(7 patients)and inhomogeneous(20 patients)^(68)Ga-PSMA uptake.The ROC analysis revealed a SUV_(max) 5.3 and SUVT/BGp1.8 as an optimal cut-off level to distinguish between non-prostate cancer and prostate cancer in ^(68)Ga-PSMA PET/CT,the sensitivity and specificity were 100.0%and 85.7%for SUV_(max)(AUC=0.979),83.3%and 90.5%for SUVT/BGp(AUC=0.915).Conclusions Pre-biopsy ^(68)Ga-PSMA PET/CT could help to distinguish between benign and malignant prostate disease before repeat prostate biopsy and detect the foci of prostate cancer.