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@ARTICLE{AfsharOromieh:134799,
author = {A. Afshar-Oromieh and L. P. Sattler and K. Steiger and T.
Holland-Letz$^*$ and M. L. da Cunha and W. Mier and O.
Neels$^*$ and K. Kopka$^*$ and W. Weichert$^*$ and U.
Haberkorn},
title = {{T}racer uptake in mediastinal and paraaortal thoracic
lymph nodes as a potential pitfall in image interpretation
of {PSMA} ligand {PET}/{CT}.},
journal = {European journal of nuclear medicine and molecular imaging},
volume = {45},
number = {7},
issn = {1619-7089},
address = {Heidelberg [u.a.]},
publisher = {Springer-Verl.},
reportid = {DKFZ-2018-00592},
pages = {1179 - 1187},
year = {2018},
abstract = {Since the introduction of 68Ga-PSMA-11 PET/CT for imaging
prostate cancer (PC) we have frequently observed mediastinal
lymph nodes (LN) showing tracer uptake despite being
classified as benign. The aim of this evaluation was to
further analyze such LN.Two patient groups with biphasic
68Ga-PSMA-11 PET/CT at 1 h and 3 h p.i. were included in
this retrospective evaluation. Group A (n = 38) included
patients without LN metastases, and group B (n = 43)
patients with LN metastases of PC. SUV of
mediastinal/paraaortal LN of group A (n = 100) were
compared to SUV of LN metastases of group B (n = 91).
Additionally, 22 randomly selected mediastinal and
paraaortal LN of patients without PC were
immunohistochemically (IHC) analyzed for PSMA expression.In
group A, 7/38 patients $(18.4\%)$ presented with at least
one PSMA-positive mediastinal LN at 1 h p.i. and 3/38
$(7.9\%)$ positive LN at 3 h p.i. with a SUVmax of
2.3 ± 0.7 at 1 h p.i. (2.0 ± 0.7 at 3 h p.i.). A
total of 11 PSMA-positive mediastinal/paraaortal LN were
detected in nine patients considering both imaging timing
points. SUVmax of LN-metastases was 12.5 ± 13.2 at 1 h
p.i. (15.8 ± 17.0 at 3 h p.i.). SUVmax increased
clearly $(> 10\%)$ between 1 h and 3 h p.i. in $76.9\%$
of the LN metastases, and decreased significantly in
$72.7\%$ of the mediastinal/paraaortal LN. By IHC,
PSMA-expression was observed in intranodal vascular
endothelia of all investigated LN groups and to differing
degrees within germinal centers of 15/22 of them $(68.1\%).$
Expression was stronger in mediastinal nodes (p = 0.038)
and when follicular hyperplasia was present
(p = 0.050).PSMA-positive mediastinal/paraaortal benign
LN were visible in a notable proportion of patients.
PSMA-positivity on the histopathological level was
associated with the activation state of the LN. However, in
contrast to LN metastases of PC, they presented with
significantly lower uptake, which, in addition, usually
decreased over time.},
cin = {C060 / E030 / L101 / L701},
ddc = {610},
cid = {I:(DE-He78)C060-20160331 / I:(DE-He78)E030-20160331 /
I:(DE-He78)L101-20160331 / I:(DE-He78)L701-20160331},
pnm = {319H - Addenda (POF3-319H)},
pid = {G:(DE-HGF)POF3-319H},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:29497802},
doi = {10.1007/s00259-018-3965-8},
url = {https://inrepo02.dkfz.de/record/134799},
}