^(68)Ga-PSMA PET/CT与多参数文MRI检查结合术后病理大切片在初诊前列腺癌中的诊断价值比较  

Comparing the diagnostic value of ^(68)Ga-PSMA PET/CT and multiparameter MRI combined with postoperative whole-mount slides pathology in initial prostate cancer diagnosis

作　　者：刘铮 万方宁 洪哲 王奇峰 刘畅 刘晓航 戴波 Liu Zheng;Wan Fangning;Hong Zhe;Wang Qifeng;Liu Chang;Liu Xiaohang;Dai Bo(Department of Urology,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai Genitourinary Cancer Institute,Shanghai 200032,China;Department of Pathology,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China;Department of Nuclear Medicine,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China;Department of Radiology,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院泌尿外科复旦大学上海医学院肿瘤学系系上海市泌尿肿瘤研究所,上海200032 [2]复旦大学附属肿瘤医院病理科复旦大学上海医学院肿瘤学系,上海200032 [3]复旦大学附属肿瘤医院核医学科复旦大学上海医学院肿瘤学系,上海200032 [4]复旦大学附属肿瘤医院放射诊断科复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中华泌尿外科杂志》2024年第6期434-438,共5页Chinese Journal of Urology

基　　金：上海市卫生健康委员会卫生健康学科带头人基金(2022XD013)。

摘　　要：目的比较^(68)Ca-前列腺特异性膜抗原(PSMA)PET/CT与多参数磁共振(mpMRI)对初诊前列腺癌分期诊断的效能。方法回顾性分析2021年12月至2023年6月复旦大学附属肿瘤医院收治的30例前列腺癌患者的病例资料。中位年龄68(67,76)岁。前列腺特异性抗原(PSA)17.91(9.41,39.53)ng/ml。患者术前均接受^(68)Ga-PSMAPET/CT和mpMRI检查,两项检查中位间隔时间21.00(2.75,35.50)d。影像学检查共发现50处病灶。患者术前均经穿刺活检病理确诊为前列腺腺癌,均未接受任何抗肿瘤治疗。所有患者均接受根治性前列腺切除术,手术切除标本术后制作病理大切片。将术后病理大切片作为金标准,比较^(68)Ga-PSMAPET/CT与mpMRI在诊断前列腺癌包膜外侵犯(EPE)、精囊腺侵犯(SVI),以及前列腺内肿瘤病灶方面的敏感性和特异性。结果本组30例,术后病理结果显示12例出现EPE,8例出现SVI。术前发现的50处病灶中,术后病理检查诊断为有临床意义前列腺癌病灶38处(76.0%)。将mpMRI、^(68)Ga-PSMAPET/CT检查图像与术后病理大切片行三重融合比较。^(68)Ga-PSMAPET/CT和mpMRI诊断EPE的敏感性分别为66.7%(8/12)和50.0%(6/12)(P=0.500),特异性分别为88.9%(16/18)和83.3%(15/18)(P=1.000);诊断SVI的敏感性分别为50.0%(4/8)和75.0%(6/8)(P=0.687),特异性分别为86.3%(19/22)和90.9%(20/22)(P=1.000);诊断有临床意义前列腺癌病灶的敏感性分别为89.5%(34/38)和63.2%(24/38)(P=0.031),特异性分别为50.0%(6/12)和33.3%(4/12)(P=0.750)。结论^(68)Ga-PSMA PET/CT诊断前列腺癌病灶的敏感性显著高于mpMRI,两种检查方法的特异性无显著差异.Objectivee To assess the diagnostic performance of ^(68)Ga-PSMA PET/CT and mpMRI in initial staging of prostate cancer.Methods A retrospective analysis was conducted on patients with initial diagnosis of prostate cancer who underwent prostatectomy at Fudan University Shanghai Cancer Center from December 2021 to June 2023.All had biopsy-confirmed prostate cancer preoperatively and had not undergone any anti-tumor treatment.Prior to surgery,all patients underwent ^(68)Ga-PSMA PET/CT and mpMRI scans.The surgical samples were processed by whole-mount slides pathology.Thirty patients were included,with a median age of 68 years(range 67-76 years).The preoperative median PSA level was 17.91 ng/ml(range 9.41-39.53 ng/ml).The median interval between the two examinations was 21.00 days(range 2.75-35.50 days).Based on the postoperative whole-mount slides pathology which was the gold standard,we compared the sensitivity and specicity of ^(68)Ga-PSMA PET/CT and mpMRI in diagnosing extraprostatic extension,seminal vesicle invasion,and intraprostatic tumor lesion.Results According to the postoperative pathology,among the 30 patients,12 had extraprostatic extension(EPE),8 had seminal vesicle invasion(SVI).Among the 50 lesions found before surgery,postoperative pathology showed that 38 of them were clinically significant prostate cancer lesions(76.0%,38/50).Using whole-mount pathology,preoperative mpMRI,and ^(68)Ga-PSMA PET/CT imaging for triple fusion comparison,the sensitivity and specificity of ^(68)Ca-PSMA PET/CT in diagnosing EPE were 66.7%(8/12)and 88.9%(16/18)respectively.The sensitivity and specificity of mpMRI in diagnosing EPE were 50.0%(6/12)and 83.3%(15/18),respectively.In diagnosing SVI,the sensitivity and specificity of ^(68)Ga-PSMA PET/CT were 50.0%(4/8)and 86.3%(19/22),respectively.The sensitivity and specificity of mpMRI were 75.0%(6/8)and 90.9%(20/22),respectively.When diagnosing clinically significant tumor lesions within the prostate,the sensitivity of ^(68)Ga-PSMA PET/CT was 89.5%(34/38),which was significant

关 键 词：前列腺癌 病理大切片 ^(68)Ga-前列腺特异性膜抗原PET/CT 多参数磁共振 诊断效能 

分 类 号：R737.25[医药卫生—肿瘤]