OBJECTIVE: Positron emission tomography (PET)/computed tomography (CT) has been shown to be a valid tool in detecting lymph node (LN) metastases in men with biochemical recurrence after radical prostatectomy.
We assessed its validity in detecting a single positive LN at pathologic examination in regard to an increasing interest in lesion-targeted salvage therapies.
METHODS AND MATERIALS: We included 46 patients with biochemical recurrence after radical prostatectomy and a single positive spot at [11C]choline PET/CT who underwent pelvic or pelvic and retroperitoneal LN dissection. The ability of [11C]choline PET/CT in identifying the exact positive LN was assessed with the positive predictive value (PPV) in the overall population and according to androgen deprivation therapy, prostate-specific antigen value, and site of PET/CT positivity.
RESULTS: Overall, 30 patients (65%) had positive LNs at pathologic examination. Of these, only 16 (35%) had pathologically confirmed metastases in the same lymphatic region and 11 (24%) had involvement of 1 single LN. Conversely, 28 patients had positive LNs in other areas and 8 had no evidence of metastases. The overall PPV of PET/CT was 34.8% and 23.9% when exact concordance was defined according to the lymphatic landing site and single positive LN, respectively. The PPV ranged from 33.3% to 44.4% and from 17.9% to 28.6%, in men with and without androgen deprivation therapy, respectively.
CONCLUSIONS: The PPV [11C]choline of PET/CT in correctly identifying patients with a single positive LN at salvage LN dissection is poor (24%). Therefore, extensive salvage treatment approaches are needed to maximize the chance of cure.
Written by:
Passoni NM, Suardi N, Abdollah F, Picchio M, Giovacchini G, Messa C, Freschi M, Montorsi F, Briganti A. Are you the author?
Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
Reference: Urol Oncol. 2013 Jun 12. pii: S1078-1439(13)00171-3.
doi: 10.1016/j.urolonc.2013.03.006
PubMed Abstract
PMID: 23769269
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