多参数磁共振成像和前列腺特异性膜抗原PET/CT对前列腺癌盆腔淋巴结转移的诊断价值比较

Comparison of the predictive value of multiparametric MRI and prostate-specific membrane antigen PET/CT for pelvic lymph node metastasis in prostate cancer

目的:比较多参数磁共振成像(mpMRI)和前列腺特异性膜抗原(PSMA)PET/CT对前列腺癌盆腔淋巴结转移的诊断效能。方法:本研究为回顾性病例系列研究。回顾性分析2020年3月至2023年9月中南大学湘雅医院泌尿外科收治的115例术前行mpMRI和PSMA PET/CT检查,并接受根治性前列腺切除和扩大盆腔淋巴结清扫术的前列腺癌患者的资料。患者年龄[ M(IQR)]67(10)岁(范围:45~84岁),体重指数24(4)kg/m^(2)(范围:18~30 kg/m^(2))。收集患者的病理学及影像学检查数据,以淋巴结的病理学检查结果作为金标准,通过诊断评价试验评估mpMRI和PSMA PET/CT诊断前列腺癌盆腔淋巴结转移的效能。组间比较采用独立样本 t检验、Mann-Whitney U非参数检验或 χ^(2)检验。 结果:mpMRI检查盆腔淋巴结转移阳性率为18.3%(21/115)。PSMA PET/CT检查盆腔淋巴结转移阳性率为25.2%(29/115)。病理学检查结果显示,淋巴结阳性率为28.7%(33/115)。基于患者的分析中,PSMA PET/CT诊断灵敏度高于mpMRI(63.6%比30.3%, χ^(2)=7.36, P=0.007)。基于病灶的分析中,PSMA PET/CT诊断灵敏度、阳性预测值均高于mpMRI(灵敏度:68.0%比21.6%, χ^(2)=42.20, P<0.01;阳性预测值:50.0%比23.1%, χ^(2)=7.54, P=0.006)。 结论:PSMA PET/CT和mpMRI对于诊断前列腺癌盆腔淋巴结转移均具有较好的特异度,但在灵敏度和病理阳性淋巴结的检出率方面PSMA PET/CT优于mpMRI。

Objective To compare the diagnostic performance of multiparametric magnetic resonance imaging(mpMRI)and prostate-specific membrane antigen(PSMA)PET/CT in detecting pelvic lymph node metastasis in prostate cancer.Methods This is a retrospective case series study.A retrospective analysis was conducted on the data of 115 prostate cancer patients who underwent both mpMRI and PSMA PET/CT before undergoing radical prostatectomy and extended pelvic lymph node dissection at the Department of Urology,Xiangya Hospital,Central South University,between March 2020 and September 2023.The age(M(IQR))was 67(10)years(range:45 to 84 years),and the body mass index was 24(4)kg/m^(2)(range:18 to 30 kg/m^(2)).Pathological and imaging data were obtained from the patients.Lymph node pathology results were used as the gold standard to evaluate the diagnostic performance of mpMRI and PSMA PET/CT for detecting pelvic lymph node metastasis in PCa through diagnostic evaluation tests.Comparisons between groups were performed using independent samples t-test,Mann-Whitney U test,orχ^(2) test.Results The positive rate for detecting pelvic lymph node metastasis was 18.3%(21/115)with mpMRI and 25.2%(29/115)with PSMA PET/CT.The pathological positive rate for lymph nodes was 28.7%(33/115).In patient-based analysis,the diagnostic sensitivity of PSMA PET/CT was significantly higher than that of mpMRI(63.6%vs.30.3%,χ^(2)=7.36,P=0.007).In lesion-based analysis,both the sensitivity and positive predictive value of PSMA PET/CT were significantly higher than those of mpMRI(sensitivity:68.0%vs.21.6%,χ^(2)=42.20,P<0.01;positive predictive value:50.0%vs.23.1%,χ^(2)=7.54,P=0.006).Conclusions:PSMA PET/CT and mpMRI both demonstrates good specificity in predicting pelvic lymph node metastasis in prostate cancer.However,PSMA PET/CT is significantly superior to mpMRI in terms of sensitivity and the detection rate of pathologically positive lymph nodes.