Additive Value of [68Ga]Ga-RM26 PET/CT to [68Ga]Ga-PSMA-617 PET/CT in Detecting Pelvic Lymph Node Metastasis in Prostate Cancer: A Prospective, Single-Center, Phase II Study

Wei Tang, Lin Qi, Minfeng Chen, Ye Zhang, Yongxiang Tang, Shuo Hu, Xiaomei Gao, Yi Cai
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引用次数: 0

Abstract

Lymph node staging in prostate cancer is crucial for treatment and prognosis, yet [68Ga]Ga-PSMA-617 PET/CT has limited sensitivity in detecting pelvic lymph node metastasis (PLNM). [68Ga]Ga-RM26 PET/CT, targeting the gastrin-releasing peptide receptor, complements [68Ga]Ga-PSMA-617 PET/CT in assessing primary tumor extension and aggressiveness. However, its role in detecting PLNM and complementing [68Ga]Ga-PSMA-617 PET/CT remains underexplored. Methods: This prospective study enrolled newly diagnosed yet untreated prostate cancer patients who underwent [68Ga]Ga-RM26 PET/CT and [68Ga]Ga-PSMA-617 PET/CT, followed by radical prostatectomy and extended pelvic lymph node dissection. The primary objective was to evaluate the diagnostic performance of both PET/CT modalities in detecting PLNM. Results: In total, 68 patients were enrolled, with a 30.9% (21/68) pathologic PLNM rate. In patient-based analysis, [68Ga]Ga-RM26 PET/CT had sensitivity and specificity of 0.43 and 0.94, respectively, compared with 0.52 and 0.89 for [68Ga]Ga-PSMA-617 PET/CT. [68Ga]Ga-RM26 PET/CT detected additional PLNMs in 50% (5/10) of patients that were missed by [68Ga]Ga-PSMA-617 PET/CT. The combined use of [68Ga]Ga-RM26 PET/CT and [68Ga]Ga-PSMA-617 PET/CT resulted in sensitivity of 0.76 and specificity of 0.85. In total, 1,049 lymph nodes were dissected, including 991 normal and 58 positive nodes. In lesion-based analysis, [68Ga]Ga-RM26 PET/CT had sensitivity and specificity of 0.38 and 0.99, respectively, compared with 0.5 and 0.99 for [68Ga]Ga-PSMA-617 PET/CT. [68Ga]Ga-RM26 PET/CT identified 41.4% (12/29) of pathologic positive nodes missed by [68Ga]Ga-PSMA-617 PET/CT. The combined [68Ga]Ga-RM26 and [68Ga]Ga-PSMA-617 PET/CT demonstrated sensitivity of 0.71 and specificity of 0.99. Conclusion: In dual-target imaging, [68Ga]Ga-RM26 PET/CT identified additional PLNMs. The combination of [68Ga]Ga-RM26 PET/CT and [68Ga]Ga-PSMA-617 PET/CT achieved higher diagnostic sensitivity with minimal loss of specificity.

[68Ga]Ga-RM26 PET/CT与[68Ga]Ga-PSMA-617 PET/CT在前列腺癌盆腔淋巴结转移检测中的附加价值:一项前瞻性、单中心、II期研究
前列腺癌的淋巴结分期对治疗和预后至关重要,但[68Ga]Ga-PSMA-617 PET/CT在检测盆腔淋巴结转移(PLNM)方面的敏感性有限。[68Ga]Ga-RM26 PET/CT,靶向胃泌素释放肽受体,补充[68Ga]Ga-PSMA-617 PET/CT评估原发性肿瘤的扩展和侵袭性。然而,其在检测PLNM和补充[68Ga]Ga-PSMA-617 PET/CT中的作用仍未得到充分探讨。方法:本前瞻性研究纳入了新诊断但未经治疗的前列腺癌患者,这些患者接受了[68Ga]Ga-RM26 PET/CT和[68Ga]Ga-PSMA-617 PET/CT,随后行根治性前列腺切除术和盆腔淋巴结清扫术。主要目的是评估PET/CT两种方式在检测PLNM方面的诊断性能。结果:共纳入68例患者,病理PLNM率为30.9%(21/68)。在基于患者的分析中,[68Ga]Ga-RM26 PET/CT的敏感性和特异性分别为0.43和0.94,而[68Ga]Ga-PSMA-617 PET/CT的敏感性和特异性分别为0.52和0.89。[68Ga]Ga-PSMA-617 PET/CT未发现PLNMs的患者中,有50%(5/10)的患者发现了额外的PLNMs。联合使用[68Ga]Ga-RM26 PET/CT和[68Ga]Ga-PSMA-617 PET/CT的敏感性为0.76,特异性为0.85。共清扫淋巴结1049个,其中正常991个,阳性58个。在基于病变的分析中,[68Ga]Ga-RM26 PET/CT的敏感性和特异性分别为0.38和0.99,而[68Ga]Ga-PSMA-617 PET/CT的敏感性和特异性分别为0.5和0.99。【68Ga】Ga-RM26 PET/CT对【68Ga】Ga-PSMA-617 PET/CT遗漏的病理阳性淋巴结的检出率为41.4%(12/29)。[68Ga]Ga-RM26和[68Ga]Ga-PSMA-617 PET/CT联合检测灵敏度为0.71,特异度为0.99。结论:在双靶成像中,[68Ga]Ga-RM26 PET/CT发现了额外的PLNMs。[68Ga]Ga-RM26 PET/CT和[68Ga]Ga-PSMA-617 PET/CT联合使用具有更高的诊断敏感性,且特异性损失最小。
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