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...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。�展开更多
This study aimed to investigate the performance of^(18)F-DCFPyL positron emission tomography/computerized tomography(PET/CT)models for predicting benign-vs-malignancy,high pathological grade(Gleason score>7),and cl...This study aimed to investigate the performance of^(18)F-DCFPyL positron emission tomography/computerized tomography(PET/CT)models for predicting benign-vs-malignancy,high pathological grade(Gleason score>7),and clinical D'Amico classifcation with machine learning.The study included 138 patients with treatment-naïve prostate cancer presenting positive^(18)F-DCFPyL scans.The primary lesions were delineated on PET images,followed by the extraction of tumor-to-backgroundbased general and higher-order textural features by applying fve diferent binning approaches.Three layer-machine learning approaches were used to identify relevant in vivo features and patient characteristics and their relative weights for predicting high-risk malignant disease.The weighted features were integrated and implemented to establish individual predictive models for malignancy(Mm),high path-risk lesions(by Gleason score)(Mgs),and high clinical risk disease(by amico)(Mamico).The established models were validated in a Monte Carlo cross-validation scheme.In patients with all primary prostate cancer,the highest areas under the curve for our models were calculated.The performance of established models as revealed by the Monte Carlo cross-validation presenting as the area under the receiver operator characteristic curve(AUC):0.97 for Mm,AUC:0.73 for Mgs,AUC:0.82 for Mamico.Our study demonstrated the clinical potential of^(18)F-DCFPyL PET/CT radiomics in distinguishing malignant from benign prostate tumors,and high-risk tumors,without biopsy sampling.And in vivo^(18)F-DCFPyL PET/CT can be considered a noninvasive tool for virtual biopsy for personalized treatment management.展开更多
<strong>Purpose:</strong> We evaluated the findings from 18F-DCFPyL PSMA PET-CTs performed on patients presenting biochemical recurrence (BCR) of prostate cancer (PCa) and assessed its impact on staging. M...<strong>Purpose:</strong> We evaluated the findings from 18F-DCFPyL PSMA PET-CTs performed on patients presenting biochemical recurrence (BCR) of prostate cancer (PCa) and assessed its impact on staging. Methods and materials: This was a multicenter retrospective analysis of patients with PCa and BCR who underwent 18F-DCFPyL PSMA PET-CT in 2020. The patients were stratified into two groups: BCR after prostatectomy (PSA ≥ 0.2 ng/mL) or BCR after radiotherapy (PSA ≥ 2 ng/mL + nadir). We analyzed the lesions according to number and location. The Shapiro-Wilk test was used to estimate the distribution of the variables. We calculated representative statistics for the quantitative variables including the mean, standard deviation, median, and interquartile range. The association between qualitative variables was examined using Chi-squared tests. <strong>Results:</strong> 40 patients with BCR were analyzed;67.5% presented disease progression, predominantly distant recurrence (42.5%), which was found exclusively in bone;55% presented ≤5 lesions and of these, 68.2% only presented 1 lesion. There was a change in staging in 66.7% of the cases;17.7% received ablative treatment with stereotactic radiotherapy (SABR). <strong>Conclusions:</strong> 18F-DCFPyL PSMA PET-CT represents a new way to manage patients with BCR that, in this study, resulted in a change in staging in 66.7% of cases and early identification of oligometastatic progressions in the subgroup of patients with PSA < 0.5 ng/mL.展开更多
文摘背景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。�
文摘This study aimed to investigate the performance of^(18)F-DCFPyL positron emission tomography/computerized tomography(PET/CT)models for predicting benign-vs-malignancy,high pathological grade(Gleason score>7),and clinical D'Amico classifcation with machine learning.The study included 138 patients with treatment-naïve prostate cancer presenting positive^(18)F-DCFPyL scans.The primary lesions were delineated on PET images,followed by the extraction of tumor-to-backgroundbased general and higher-order textural features by applying fve diferent binning approaches.Three layer-machine learning approaches were used to identify relevant in vivo features and patient characteristics and their relative weights for predicting high-risk malignant disease.The weighted features were integrated and implemented to establish individual predictive models for malignancy(Mm),high path-risk lesions(by Gleason score)(Mgs),and high clinical risk disease(by amico)(Mamico).The established models were validated in a Monte Carlo cross-validation scheme.In patients with all primary prostate cancer,the highest areas under the curve for our models were calculated.The performance of established models as revealed by the Monte Carlo cross-validation presenting as the area under the receiver operator characteristic curve(AUC):0.97 for Mm,AUC:0.73 for Mgs,AUC:0.82 for Mamico.Our study demonstrated the clinical potential of^(18)F-DCFPyL PET/CT radiomics in distinguishing malignant from benign prostate tumors,and high-risk tumors,without biopsy sampling.And in vivo^(18)F-DCFPyL PET/CT can be considered a noninvasive tool for virtual biopsy for personalized treatment management.
文摘<strong>Purpose:</strong> We evaluated the findings from 18F-DCFPyL PSMA PET-CTs performed on patients presenting biochemical recurrence (BCR) of prostate cancer (PCa) and assessed its impact on staging. Methods and materials: This was a multicenter retrospective analysis of patients with PCa and BCR who underwent 18F-DCFPyL PSMA PET-CT in 2020. The patients were stratified into two groups: BCR after prostatectomy (PSA ≥ 0.2 ng/mL) or BCR after radiotherapy (PSA ≥ 2 ng/mL + nadir). We analyzed the lesions according to number and location. The Shapiro-Wilk test was used to estimate the distribution of the variables. We calculated representative statistics for the quantitative variables including the mean, standard deviation, median, and interquartile range. The association between qualitative variables was examined using Chi-squared tests. <strong>Results:</strong> 40 patients with BCR were analyzed;67.5% presented disease progression, predominantly distant recurrence (42.5%), which was found exclusively in bone;55% presented ≤5 lesions and of these, 68.2% only presented 1 lesion. There was a change in staging in 66.7% of the cases;17.7% received ablative treatment with stereotactic radiotherapy (SABR). <strong>Conclusions:</strong> 18F-DCFPyL PSMA PET-CT represents a new way to manage patients with BCR that, in this study, resulted in a change in staging in 66.7% of cases and early identification of oligometastatic progressions in the subgroup of patients with PSA < 0.5 ng/mL.
