Accuracy of 68Ga-Prostate-specific Membrane Antigen Positron Emission Tomography for the Detection of Lymph Node Metastases Before Salvage Lymphadenectomy.

Imaging modalities with high accuracy are essential for proper selection of patients for salvage lymph node dissection (sLND). Unlike nodal staging before radical prostatectomy, data on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) before sLND are scarce. We analyzed 23 patients undergoing 68Ga-PSMA-PET before sLND and compared the imaging findings with histopathology at sLND. Altogether, 29/109 resected lymph node (LN) fields harbored histologically confirmed LN metastases (26.6%)., The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 89.5%, 74.1%, 70.8%, 90.9%, and 80.4% in side-based analysis, and 75.9%, 87.5%, 68.8%, 90.9%, and 84.4%, respectively, in LN field-based analysis. In contrast to existing studies, sensitivity in particular was lower. This might be because of referral for sLND on the basis of PSMA-PET from 13 different nuclear medicine centers. However, this could still provide more realistic data if sLND should become widely used. Second, our pathologists routinely used immunohistochemistry, resulting in a higher yield of smaller metastases, increasing the accuracy of histopathology. Despite its acceptable accuracy in a real-world scenario, sLND should not only focus on PSMA-PET-positive fields, as small PSMA-PET-negative metastases may be present.

We analyzed the accuracy of prostate-specific membrane antigen positron emission tomography (PSMA-PET) before salvage lymph node dissection in a real-world situation. Although the accuracy is reasonable, resection should not exclusively focus on PSMA-PET-positive fields.

European urology focus. 2018 Jul 23 [Epub ahead of print]

Philipp Mandel, Derya Tilki, Felix K Chun, Eugenia Pristupa, Markus Graefen, Susanne Klutmann, Lars Budäus, Thomas Steuber

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Frankfurt, Frankfurt, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: ., Department of Urology, University Hospital Frankfurt, Frankfurt, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe