Document Detail


11C-choline positron emission tomography/computerized tomography for preoperative lymph-node staging in intermediate-risk and high-risk prostate cancer: comparison with clinical staging nomograms.
MedLine Citation:
PMID:  18456393     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Conventional imaging (CI) techniques are inadequate for lymph node (LN) staging in prostate cancer (PCa). OBJECTIVES: To assess the accuracy of (11)C-Choline positron emission tomography/computerized tomography (PET/CT) for LN staging in intermediate-risk and high-risk PCa and to compare it with two currently used nomograms. DESIGN, SETTING, AND PARTICIPANTS: From January 2007 to September 2007, 57 PCa patients at intermediate risk (n=27) or high risk (n=30) were enrolled at two academic centres. All patients underwent preoperative PET/CT and radical prostatectomy with extended pelvic LN dissection (PLND). Risk of LN metastasis (LNM) was assessed using available nomograms. MEASUREMENTS: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and number of correctly recognized cases for LNM detection at PET/CT were assessed. The accuracy of PET/CT for LNM detection was compared with the accuracy of nomograms for LNM prediction by using receiver operating characteristic (ROC) analysis. RESULTS AND LIMITATIONS: Fifteen patients (26%) had LNMs, and a total of 41 LNMs were identified. On a patient analysis, sensitivity, specificity, PPV, NPV, and number of correctly recognized cases at PET/CT were 60.0%, 97.6%, 90.0%, 87.2%, and 87.7% while, on node analysis, these numbers were 41.4%, 99.8%, 94.4%, 97.2%, and 97.1%. The mean diameter (in mm) of the metastatic deposit of true-positive LNs was significantly higher than that of false-negative LNs (9.2 vs 4.2; p=0.001). PET/CT showed higher specificity and accuracy than the nomograms; however, in pairwise comparison, the areas under the curve (AUCs) were not statistically different (all p values >0.05). CONCLUSIONS: In patients with intermediate-risk and high-risk PCa, (11)C-Choline PET/CT has quite a low sensitivity for LNM detection but performed better than clinical nomograms, with equal sensitivity and better specificity.
Authors:
Riccardo Schiavina; Vincenzo Scattoni; Paolo Castellucci; Maria Picchio; Barbara Corti; Alberto Briganti; Alessandro Franceschelli; Francesco Sanguedolce; Alessandro Bertaccini; Moshen Farsad; Giampiero Giovacchini; Stefano Fanti; Walter Franco Grigioni; Ferruccio Fazio; Francesco Montorsi; Patrizio Rigatti; Giuseppe Martorana
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-04-18
Journal Detail:
Title:  European urology     Volume:  54     ISSN:  1873-7560     ISO Abbreviation:  Eur. Urol.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-01     Completed Date:  2009-06-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7512719     Medline TA:  Eur Urol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  392-401     Citation Subset:  IM    
Affiliation:
Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Carbon Radioisotopes / diagnostic use*
Choline / diagnostic use*
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Staging
Nomograms*
Positron-Emission Tomography*
Preoperative Care
Prostatic Neoplasms / pathology*,  radionuclide imaging*,  surgery
Reproducibility of Results
Risk Assessment
Tomography, X-Ray Computed*
Chemical
Reg. No./Substance:
0/Carbon Radioisotopes; 62-49-7/Choline
Comments/Corrections
Comment In:
Eur Urol. 2008 Aug;54(2):400-1   [PMID:  18456392 ]

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