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@ARTICLE{Vinsensia:131624,
author = {M. Vinsensia and P. L. Chyoke and B. Hadaschik and T.
Holland-Letz$^*$ and J. Moltz and K. Kopka$^*$ and I.
Rauscher and W. Mier and M. Schwaiger and U. Haberkorn$^*$
and T. Mauer and C. Kratochwil and M. Eiber and F.
Giesel$^*$},
title = {68{G}a-{PSMA} {PET}/{CT} and {V}olumetric {M}orphology of
{PET}-{P}ositive {L}ymph {N}odes {S}tratified by {T}umor
{D}ifferentiation of {P}rostate {C}ancer.},
journal = {Journal of nuclear medicine},
volume = {58},
number = {12},
issn = {2159-662X},
address = {New York, NY},
publisher = {Soc.},
reportid = {DKFZ-2017-06256},
pages = {1949 - 1955},
year = {2017},
abstract = {68Ga-prostate-specific membrane antigen (PSMA) PET/CT is a
new method to detect early nodal metastases in patients with
biochemical relapse of prostate cancer. In this
retrospective investigation, the dimensions, volume,
localization, and SUVmax of nodes identified by 68Ga-PSMA
were correlated to their Gleason score (GS) at diagnosis.
Methods: All PET/CT images were acquired 60 ± 10 min after
intravenous injection of 68Ga-PSMA (mean dose, 176 MBq). In
147 prostate cancer patients (mean age, 68 y; range, 44-87
y) with prostate-specific antigen relapse (mean
prostate-specific antigen level, 5 ng/mL; range, 0.25-294
ng/mL), 362 68Ga-PSMA PET-positive lymph nodes (LNs) were
identified. These patients were classified on the basis of
their histopathology at primary diagnosis into either low-
(GS ≤ 6, well differentiated), intermediate- (GS = 7,
moderately differentiated), or high-GS cohorts (GS ≥ 8,
poorly differentiated prostate cancer). Using semiautomated
LN segmentation software (Fraunhofer MEVIS), we measured
node volume and short-axis dimensions (SADs) and long-axis
dimensions based on CT and compared with the SUVmax Nodes
demonstrating uptake of 68Ga-PSMA with an SUVmax of 2.0 or
more were considered PSMA-positive, and nodes with an SAD of
8 mm or more were considered positive by morphologic
criteria. Results: Mean SUVmax was 13.5 $(95\%$ confidence
interval [CI], 10.9-16.1), 12.4 $(95\%$ CI, 9.9-14.9), and
17.8 $(95\%$ CI, 15.4-20.3) within the low-, intermediate-,
and high-GS groups, respectively. The morphologic assessment
of the 68Ga-PSMA-positive LN demonstrated that the low-GS
cohort presented with smaller 68Ga-PSMA-positive LNs (mean
SAD, 7.7 mm; n = 113), followed by intermediate- (mean SAD,
9.4 mm; n = 122) and high-GS cohorts (mean SAD, 9.5 mm; n =
127). On the basis of the CT morphology criteria, only
$34\%$ of low-GS patients, $56\%$ of intermediate-GS
patients, and $53\%$ of high-GS patients were considered CT
positive. Overall, 68Ga-PSMA imaging led to a
reclassification of stage in 90 patients $(61\%)$ from cN0
to cN1 over CT. Conclusion:68Ga-PSMA PET is a promising
modality in biochemical recurrent prostate cancer patients
for N staging. Conventional imaging underestimates LN
involvement compared with PSMA molecular staging score in
each GS cohort. The sensitivity of 68Ga-PSMA PET/CT enables
earlier detection of subcentimeter LN metastases in the
biochemical recurrence setting.},
keywords = {(68Ga)Glu-urea-Lys(Ahx)-HBED-CC (NLM Chemicals) / Antigens,
Surface (NLM Chemicals) / Organometallic Compounds (NLM
Chemicals) / Radiopharmaceuticals (NLM Chemicals) /
Glutamate Carboxypeptidase II (NLM Chemicals) / glutamate
carboxypeptidase II, human (NLM Chemicals)},
cin = {C060 / E030 / E060},
ddc = {610},
cid = {I:(DE-He78)C060-20160331 / I:(DE-He78)E030-20160331 /
I:(DE-He78)E060-20160331},
pnm = {315 - Imaging and radiooncology (POF3-315)},
pid = {G:(DE-HGF)POF3-315},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:28637799},
doi = {10.2967/jnumed.116.185033},
url = {https://inrepo02.dkfz.de/record/131624},
}