Abstract
INTRODUCTION AND OBJECTIVES: Recently, Glu-NH-CONH-Lys-(Ahx)-[(68)Ga(HBED-CC)] as a novel 68Gallium-labelled ligand of the prostate-specific membrane antigen (68Ga-HBEDPSMA) has been introduced for the diagnostic evaluation of prostate cancer (PCa) patients. The aim of this study was to evaluate the accuracy of preoperative 68Ga-HBED-PSMA PET with the results of postoperative histological findings after radical prostatectomy (RP) and pelvine template lymph node (LN) dissection with regard to metastatic LN involvement. METHODS: 92 consecutive patients with intermediate to highrisk PCa patients were included. All patients received 68Ga-HBEDPSMA PET hybrid imaging prior to surgery. Pelvine template LN dissection was performed according to 8 predefined anatomical fields. In all patients LN involvement was evaluated in a blinded fashion according to a 5-point scale (1 1⁄4 metastatic; 2 1⁄4 probably metastatic; 3 1⁄4 equivocal; 4 1⁄4 probably benign; 5 1⁄4 benign) on a patientand field-based manner and correlated to postoperative histological analysis. RESULTS: Due to lacking PSMA expression of the primary tumor 4 patients were excluded from further analysis. In total, 20 patients showed metastatic LN. 68Ga-HBED-PSMA PET detected 15 out of 20 patients with histological proven metastatic LN (sensitivity: 75.0%) and correctly classified all 68 patients without histological evidence of LN metastases (specificity: 100%; accuracy 94.3%; PPV: 100%; NPV: 93.2%). 5 patients without evidence of metastatic LN on imaging showed only small metastases in single LN (3 patients with one positive LN, 2 patients with two LN). In total, 470 anatomical fields could be analysed (52 with LN metastases). Sensitivity, specificity, accuracy, PPV and NPV for the field-based analysis were calculated as 73.1%, 98.6%, 95.7%, 86.4% and 96.7%, respectively. CONCLUSIONS: 68Ga-HBED-PSMA PET hybrid imaging shows a high sensitivity as well as superb specificity and accuracy for lymph node staging in intermediate to high-risk PCa patients and might replace current standard imaging (sole MRI, CT or PET using FDG or choline-based tracers) in the future.
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