^(18)F-DCFPyL PET/CT的不同诊断标准对前列腺癌原发病灶的诊断价值

Diagnostic values of different diagnostic criteria of^(18)F-DCFPyL PET/CT for primary prostate cancer

目的比较不同前列腺特异膜抗原(PSMA)PET/CT诊断标准对前列腺癌(PCa)原发病灶的诊断价值。方法回顾性分析2019年5月至2021年5月在山西白求恩医院接受2-(3-(1-羧基-5-[(6-^(18)F-氟-吡啶-3-羰基)-氨基]-戊基)-脲基)戊二酸(^(18)F-DCFPyL)PET/CT显像的78例可疑PCa患者[年龄:(68.5±1.4)岁]影像资料,分别采用SUV_(max)、PSMA报告和数据系统(PSMA-RADS)评分、分子成像PSMA(miPSMA)评分进行盲法诊断,自身对照比较3个标准对PCa的诊断效能、与疾病危险度的相关性以及结果的一致性。采用Delong检验、Spearman秩相关分析及组内相关系数(ICC)分析数据。结果SUV_(max)、PSMA-RADS评分、miPSMA评分诊断PCa原发病灶的灵敏度均为93.75%(60/64),特异性分别为12/14、10/14、12/14;AUC分别为0.951、0.862、0.951,SUV_(max)与miPSMA评分的AUC差异无统计学意义(z=0.00,P=1.000),而PSMA-RADS评分与SUV_(max)、miPSMA评分的AUC差异有统计学意义(z值:2.71、2.93,P值:0.007、0.030)。SUV_(max)、PSMA-RADS评分、miPSMA评分诊断结果与疾病危险度呈正相关[与国际泌尿病理学会(ISUP)分级的r_(s)分别为0.66、0.62、0.63,均P<0.001;与D′Amico分组的r_(s)分别为0.67、0.64、0.67,均P<0.001]。^(18)F-DCFPyL PET/CT基于3个标准诊断PCa的结果具有高度一致性(ICC=0.941,95%CI:0.903~0.967)。结论SUV_(max)与miPSMA评分对PCa原发病灶具有更高诊断效能、更高的疾病危险度相关性,更适合临床规范化应用。

Objective To compare the diagnostic values of different diagnostic criteria of prostate specific membrane antigen(PSMA)PET/CT for primary prostate cancer(PCa).Methods From May 2019 to May 2021,2-(3-(1-carboxy-5-((6-^(18)F-fluoro-pyridine-3-carbonyl)-amino)-pentyl)-ureido)-pentanedioic acid(^(18)F-DCFPyL)PET/CT images of 78 patients(age:(68.5±1.4)year_(s))with clinically suspected PCa in Shanxi Bethune Hospital were retrospectively collected and blind diagnosed by the three criteria of SUV_(max),PSMA reporting and data system(PSMA-RADS)score and molecular imaging PSMA(miPSMA)score.The diagnostic efficacy for PCa,the correlation between the diagnostic results and disease risk,and the consistency of the diagnostic results of the three criteria were compared.Delong test,Spearman rank correlation analysis,and intra-class correlation coefficient(ICC)were used to analyze data.Results The sensitivities of SUV_(max),PSMA-RADS score and miPSMA score for PCa were all 93.75%(60/64)and the specificities were 12/14,10/14 and 12/14 respectively;AUCs of the three criteria were 0.951,0.862 and 0.951,with no significant difference between SUV_(max)and miPSMA score(z=0.00,P=1.000),while there were significant differences between PSMA-RADS score and SUV_(max)or miPSMA score(z values:2.71,2.93,P values:0.007,0.030).There were positive correlations between the diagnostic results of the three criteria and the disease risk(International Society of Urological Pathology(ISUP)grading:r_(s)values:0.66,0.62,0.63,all P<0.001;D′Amico grouping:r_(s)values:0.67,0.64,0.67,all P<0.001).The diagnostic results of the three criteria were highly consistent(ICC=0.941,95%CI:0.903-0.967).Conclusion The SUV_(max)and miPSMA score have higher diagnostic efficiency and correlation of disease risk,which are more suitable for clinical application.