18F-DCFPyL PET/CT和mpMRI单独与联合使用对中高危前列腺癌盆腔淋巴结转移、包膜外侵犯及精囊腺侵犯的诊断效能比较

18F-DCFPyL PET/CT combined with mpMRI in diagnosis of intermediate-to high-risk prostate cancer with pelvic lymph node metastasis,extraprostatic extension and seminal vesicle invasion

背景18F-DCFPyL PET/CT和多参数磁共振(multiparametric magnetic resonance imaging,mpMRI)等单一影像学检查评价前列腺癌的盆腔淋巴结转移及局部侵犯仍有局限性。目的比较18F-DCFPyL PET/CT与mpMRI单独使用及两者联合对中高危前列腺癌盆腔淋巴结转移、包膜外侵犯及精囊腺侵犯的诊断效能。方法回顾性分析2018年1月-2022年6月于解放军总医院第一医学中心行18F-PSMA PET/CT及mpMRI检查,并行机器人辅助腹腔镜下前列腺根治性切除术及扩大盆腔淋巴结清扫术的中高危前列腺癌患者的临床资料。以术后病理结果为金标准,比较18F-DCFPyL PET/CT、mpMRI及两者联合对前列腺癌盆腔淋巴结转移、前列腺包膜侵犯和精囊腺侵犯的诊断效能。结果共纳入74例中高危前列腺癌患者,平均年龄(66.8±6.7)岁。中危组26例(35.1%),高危组48例(64.9%)。血清总前列腺特异抗原中位值15.3(IQR:9.4~26.1)ng/mL,术前前列腺穿刺活检Gleason评分7分33例,8分20例,≥9分21例。18F-DCFPyL PET/CT在诊断盆腔局部淋巴结转移方面较mpMRI具有更高的敏感度(57.1%vs 28.6%)和特异度(98.5%vs 97%),AUC更高(0.78 vs 0.63,P=0.106);两者联合与18F-DCFPyL PET/CT比较,未显示出更佳的诊断效能(AUC:0.76 vs 0.78,P=0.154)。在检测精囊腺侵犯方面,单独使用mpMRI较18F-DCFPyL PET/CT具有更高的敏感度(66.7%vs 58.3%)和特异度(95.2%vs 91.9%),AUC更高(0.81 vs0.75,P=0.185);两者联合的诊断效能较mpMRI稍有提高,但差异无统计学意义(AUC:0.83 vs 0.81,P=0.690)。在诊断包膜外侵犯方面,与单独使用18F-DCFPyL PET/CT相比,使用mpMRI(AUC:0.75 vs 0.64,P=0.007)具有更高的诊断效能,两者联合未见效能提高(AUC:0.73 vs 0.75,P=0.152)。结论术前联合使用mpMRI与18F-DCFPyL PET/CT可能有助于评估前列腺癌精囊腺侵犯情况。单独使用18F-DCFPyL PET/CT诊断中高危前列腺癌盆腔淋巴结转移具有很高的特异度,其结果有助于判断是否行盆腔淋巴结清扫术。对于前列腺癌包膜外侵犯,单独使用mpMRI表现出更高的诊断准确率。

Background There are still limitations in evaluating pelvic lymph node metastasis and local invasion of prostate cancer using single imaging examination such as 18F-DCFPyL PET/CT or multi-parameter magnetic resonance imaging(mpMRI).Objective To compare the diagnostic efficacy of 18F-DCFPyL PET/CT and mpMRI alone or in combination for intermediate to high-risk prostate cancer with pelvic lymph node metastasis,extraprostatic extension and seminal vesicle invasion.Methods Clinical data about patients with intermediate to high-risk prostate cancer who underwent 18F-DCFPyL PET/CT and mpMRI with roboticassisted laparoscopic radical prostatectomy(RARP)and expanded pelvic lymph node dissection(ePLND)in Chinese PLA General Hospital from January 2018 to June 2022 were retrospectively analyzed.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of 18F-DCFPyL PET/CT,mpMRI and the combination of both for the diagnosis of pelvic lymph node metastasis,extraprostatic extension and seminal vesicle invasion in prostate cancer were compared using the postoperative pathological results as the gold standard.Results A total of 74 patients with intermediate to high-risk prostate cancer were included,with a mean age of(66.8±6.7)years.There were 26 cases(35.1%)in the intermediate-risk group and 48 cases(64.9%)in the highrisk group.The median tPSA value was 15.3(IQR:9.4~26.1)ng/mL,and the preoperative Gleason score was 7 in 33 cases,8 in 20 cases and≥9 in 21 cases.18F-DCFPyL PET/CT had higher sensitivity(57.1%vs 28.6%),specificity(98.5%vs 97%),and AUC(0.78 vs 0.63,P=0.106)compared to mpMRI in the diagnosis of pelvic lymph node metastases,and the combination of the two did not show better diagnostic performance(AUC:0.76 vs 0.78,P=0.154).In detecting seminal vesicle invasion,using mpMRI alone had higher sensitivity(66.7%vs 58.3%)and specificity(95.2%vs 91.9%)than 18F-DCFPyL PET/CT,with a higher AUC(0.83 vs 0.75,P=0.185),and the combination of the two didn’t improve the diagnostic performance significantly(AUC:0.83 vs 0.81,P=0.690).In the diagnosis of extraprostatic invasion,the use of mpMRI had higher AUC compared to 18F-DCFPyL PET/CT alone(0.75 vs 0.64,P=0.007),and no significant improvement was seen when the two were combined(AUC:0.73 vs 0.75,P=0.152).Conclusion The preoperative combination of mpMRI with 18F-DCFPyL PET/CT may be useful in assessing seminal vesicle invasion in prostate cancer.The use of 18F-DCFPyL PET/CT alone,which is highly specific for the diagnosis of pelvic lymph node metastases in intermediate-to-high-risk prostate cancer,can help in making decisions about whether to perform pelvic lymph node dissection.However,the use of mpMRI alone shows better diagnostic accuracy for extraprostatic invasion.