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Detection Rate of 18F-Choline PET/CT and 68Ga-PSMA-HBED-CC PET/CT for Prostate Cancer Lymph Node Metastases with Direct Link from PET to Histopathology: Dependence on the Size of Tumor Deposits in Lymph Nodes.

  • Jilg CA Department of Urology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany cordula.jilg@uniklinik-freiburg.de.
  • Drendel V Institute for Pathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  • Rischke HC Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Beck TI Department of Nuclear Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Reichel K Department of Urology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  • Krönig M Department of Urology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  • Wetterauer U Department of Urology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  • Schultze-Seemann W Department of Urology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  • Meyer PT Department of Nuclear Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
  • Vach W Department of Orthopedics and Traumatology, University Hospital Basel, Switzerland; and.
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  • 2019-01-27
Published in:
  • Journal of nuclear medicine : official publication, Society of Nuclear Medicine. - 2019
PSMA-PET/CT
choline-PET/CT
detection rate
lymph node metastases
prostate cancer
Aged
Choline
Edetic Acid
Humans
Lymph Node Excision
Lymphatic Metastasis
Male
Membrane Glycoproteins
Organometallic Compounds
Positron Emission Tomography Computed Tomography
Prostatic Neoplasms
Retrospective Studies
Tumor Burden
English Accurate detection of prostate cancer lymph node metastases (LNM) through PET/CT before lymphadenectomy is crucial for successful therapy. PET/CT with choline derivatives used to be the standard tool for imaging metastases, whereas 68Ga-PSMA (prostate-specific membrane antigen) PET/CT was introduced recently. Both PET techniques were investigated with respect to what extent the detection rate of LNM depends on the size of tumor deposits (TDs) within LNM. Methods: Documenting the switch from the use of 18F-choline to 68Ga-PSMA in 2014, we used 2 patient cohorts undergoing a template lymphadenectomy because of a PET/CT indicating LNM. Forty-four and 40 patients underwent PET/CT with 18F-choline or 68Ga-PSMA ligand, respectively. In total, 226 LNM (125 18F-choline, 101 68Ga-PSMA) originated from 73 salvage lymphadenectomies at biochemical recurrence and from 11 primary lymphadenectomies at radical prostatectomy. LNM eligible for direct correlation of PET/CT to histopathology were identified from lymphadenectomies conducted in small anatomic subregions, with 1 LNM (condition 1) or 1-2 LNM (condition 2). Longitudinal and short diameters of TD within LNM were determined by histopathology, allowing linking of the size of TD in LNM to the detection threshold of PET/CT. Diameters associated with a detection rate of 50% and 90% (d50%, d90%) were calculated on the basis of logistic growth curve models fitted. Results: Gleason score, number of removed LNs, and subregions for lymphadenectomy per patient did not differ significantly between the 18F-choline and 68Ga-PSMA groups. The median prostate-specific antigen level at imaging and number of LNM per patient were significantly higher in the 18F-choline group (3.4 ng/mL, n = 34) than in the 68Ga-PSMA group (2.2 ng/mL, n = 28; both P < 0.05). Longitudinal and short diameters of TD in LNM to reach d90% were 11.2 and 7.4 mm, respectively, for 18F-choline PET/CT and 6.3 and 4.9 mm, respectively, for 68Ga-PSMA PET/CT. Corresponding diameters to reach d50% were 5.5 and 3.3 mm, respectively, for 18F-choline PET/CT and 3.7 and 2.3 mm, respectively, for 68Ga-PSMA PET/CT. Detection rates were significantly higher under 68Ga-PSMA (P = 0.005 and 0.04 for longitudinal and short diameter). Conclusion: 68Ga-PSMA PET/CT is superior to 18F-choline PET/CT in the detection of LNM. Whether those results will lead to an improved patient outcome after 68Ga-PSMA PET-guided therapy needs to be investigated by further studies.
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  • English
Open access status
bronze
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https://sonar.ch/global/documents/232439
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