68Ga-PSMA-11 PET-CT对初诊前列腺癌患者阳性发现的效果评价

目的 探讨以68镓(68Ga)标记的靶向前列腺特异性膜抗原(PSMA)分子探针PSMA-11为示踪剂的PET-CT(68Ga-PSMA-11 PET-CT)检测初诊前列腺癌患者的阳性发现情况.方法 回顾性分析2019年1月至12月经前列腺活体组织穿刺病理学初次确诊、于海军军医大学(第二军医大学)长海医院行68Ga-PSMA-11 PET-CT检查的45例前列腺癌患者的影像学及临床资料.采用二分类判别法定性分析68Ga-PSMA-11 PET-CT图像,以诊断前列腺癌原发灶是否累及前列腺两叶、突破包膜、侵犯精囊和发生区域淋巴结转移.以根治性切除术标本的病理学结果为金标准,对影像-病理的配对样本进行McNemar检验,并计算Kappa系数.结果 68Ga-PSMA-11 PET-CT检测初诊前列腺癌患者的原发灶累及前列腺两叶、突破包膜、侵犯精囊和发生区域淋巴结转移的准确度分别为60.0％(27/45)、57.8％(26/45)、75.6％(34/45)和84.4％(38/45),Kappa 系数分别为0.075(P=0.375)、0.249(P=0.025)、0.409(P=0.003)和0.444(P=0.002).结论 68Ga-PSMA-11 PET-CT对判断初诊前列腺癌患者病灶是否存在侵犯精囊和发生区域淋巴结转移有一定价值,但对是否累及前列腺两叶和突破包膜的诊断价值较低.

Evaluation of 68Ga-PSMA-11 PET-CT for positive findings in patients with newly diagnosed prostate cancer

Objective To explore the consistency between the positive findings of 68Ga-PSMA-11 PET/CT and pathology of radical prostatectomy in patients with newly diagnosed prostate cancer. Methods The clinical data of 45 patients (median age 70 years) with prostate cancer newly diagnosed by biopsy and followed by 68Ga-PSMA-11 PET/CT imaging from January 2019 to December 2019 were analyzed retrospectively.The 68Ga-PSMA-11 PET/CT images of patients with prostate cancer were qualitatively analyzed to dichotomily diagnosing involvement of the prostate bilobes, capsules, seminal vesicles and regional lymph nodes. Taking the pathology of radical surgery as the gold standard, the McNemar consistency test of image-pathology paired samples was carried out, and the Kappa coefficient is calculated. Pathological data and image data are mutually blind data. Results The accuracy of 68Ga-PSMA-11 PET/CT in the diagnosis in tumor invasion of prostate bilobes, capsules, seminal vesicles and regional lymph nodes was 60.0%, 57.8%, 75.6%, 84.4%, respectively, and the Kappa coefficients were 0.075 (P=0.375), 0.249 (P=0.025), 0.409 (P=0.003), 0.444 (P=0.002), respectively. Conclusion Compared with the gold standard of pathology of radical surgery, 68Ga-PSMA-11 PET/CT is of lower consistent in detecting involvement of prostate bilobes and capsules, and moderately in that of seminal vesicles and regional lymph nodes.