^(68)Ga-PSMA-PET/CT对前列腺癌盆腔淋巴结转移诊断价值的研究  

Diagnostic value of ^(68)Ga-PSMA-PET/CT in pelvic lymph node metastasis of prostate cancer

作　　者：单兴利 王栋 邢念增 肖泽均 李亚健 Shan Xingli;Wang Dong;Xing Nianzeng;Xiao Zejun;Li Yajian(Department of Urology,Cancer Hospital of Huanxing,ChaoYang District,Beijing 100122,China;Department of Urology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]北京市朝阳区桓兴肿瘤医院泌尿外科,100122 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院泌尿外科,北京100021

出　　处：《中华腔镜泌尿外科杂志（电子版）》2023年第3期214-218,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：北京市朝阳区科技计划项目(CYSF1918)。

摘　　要：目的分析^(68)Ga-PSMA-PET/CT诊断前列腺癌盆腔淋巴结转移(LNM)与手术病理的一致性程度,用以指导临床。方法回顾性分析44例术前完成^(68)Ga-PSMA-PET/CT的前列腺癌3D腹腔镜下根治性切除术+盆腔淋巴结清扫术患者的病历资料,观察^(68)Ga-PSMA-PET/CT对于盆腔淋巴结转移的诊断价值。结果患者中位年龄66(60,69)岁,初始PSA 17(11,30)ng/ml。^(68)Ga-PSMA-PET/CT淋巴结情况被描述为三种类型:Ⅰ、未见淋巴结转移;Ⅱ、可能淋巴结转移;Ⅲ、考虑淋巴结转移。将类型Ⅰ、Ⅱ定义为阴性,类型Ⅲ定义为阳性。^(68)Ga-PSMA-PET/CT的LNM阳性率为25.00%(11/44),病理LNM阳性率为13.64%(6/44),6例病理LNM阳性患者全部为高危组,ISUP分级分别为G3(1/6)及G5(5/6)。总体^(68)Ga-PSMA-PET/CT诊断LNM的灵敏度为83.33%(5/6),特异度为84.21%(32/38),诊断符合率为84.09%(37/44),阴性预测值为96.97%(32/33),阳性预测值为45.45%(5/11)。Kappa系数一致性检验显示其与病理诊断LNM存在较强程度的一致性,Kappa=0.601,P<0.05(Z=4.109,P<0.001,SEM=0.159,95%CI:0.291~0.912)。结论^(68)Ga-PSMA-PET/CT用于前列腺癌患者诊断盆腔淋巴结转移与手术病理存在较强的一致性,其表现出的高阴性预测值临床应用价值很高,但不能取代盆腔淋巴结清扫术的地位。Objective To analyze the consistency between the application of^(68)Ga-PSMA-PET/CT in the diagnosis of pelvic lymph node metastasis(LNM)of prostate cancer and surgical pathology,so as to guide the clinical practice.Methods The medical records of 44 patients with prostate cancer who completed^(68)Ga-PSMA-PET/CT preoperative 3D laparoscopic radical resection and pelvic lymph node dissection were analyzed retrospectively,and the diagnostic value of^(68)Ga-PSMA-PET/CT for pelvic lymph node metastasis was observed.Results The patients median age was 66(60,69)years,and the initial PSA was 17(11,30)ng/ml.^(68)Ga-PSMA-PET/CT lymph node was described as 3 types:Ⅰ,no lymph node metastasis;Ⅱ,possible lymph node metastasis;Ⅲ,considering lymph node metastasis.Types Ⅰ and Ⅱ were defined as negative,and type Ⅲ was defined as positive.The LNM positive rate of^(68)Ga-PSMA-PET/CT was 25.00%(11/44),and the pathological LNM positive rate was 13.64%(6/44),of which G3(1/6)and G5(5/6).The overall sensitivity of^(68)Ga-PSMA-PET/CT in the diagnosis of LNM was 83.33%(5/6),specificity was 84.21%(32/38),diagnostic coincidence rate was 84.09%(37/44),negative predictive value was 96.97%(32/33),positive predictive value was 45.45%(5/11).The Kappa coefficient consistency test showed that it had a strong degree of consistency with the pathological diagnosis of LNM,Kappa=0.601,P<0.05(Z=4.109,P<0.001,SEM=0.159,95%CI:0.291-0.912).Conclusions The application of^(68)Ga-PSMA-PET/CT in the diagnosis of pelvic lymph node metastasis in prostate cancer patients has a strong degree of consistency with the surgical pathology,and its high negative predictive value is of high clinical application value,but it can not replace the status of pelvic lymph node dissection.

关 键 词：前列腺肿瘤 ^(68)Ga-PSMA-PET/CT 3D 腹腔镜 前列腺切除术 淋巴结转移 

分 类 号：R737.25[医药卫生—肿瘤]