ABSTRACT
Antecedentes y objetivos: Comparar prospectivamente la tasa de detección de la PET/TC con 68Ga-DOTATATE versus 11C-colina en pacientes con cáncer de próstata en recaída bioquímica y evaluar in vivo la expresión de receptores de la somatostatina con el fin de planificar terapias dirigidas (177Lu-DOTATATE). Material y métodos: Analizamos prospectivamente 64 pacientes con recaída bioquímica (mediana PSA: 4,25 ng/mL). Se realizó una PET/TC con 11C-colina y otra con 68Ga-DOTATATE. Se midió el SUVmáx en todas las lesiones. Se consideraron como patrón de referencia las imágenes correlativas, histopatología y/o seguimiento clínico y bioquímico. Resultados: La tasa de detección global por paciente fue del 48,43% para 68Ga-DOTATATE y de 46,87% para 11C-colina. Los resultados fueron concordantes en 53 casos (82,81%). El SUV máximo de la 11C-colina fue significativamente mayor que el correspondiente al 68Ga-DOTATATE para todas las lesiones concordantes (n = 130): 6,17 (1,7-15,5) versus 4,38 (1,37-26,7), mediana (rango), para cada radiotrazador, respectivamente (P < 0,0001). Los valores por paciente de sensibilidad y especificidad fueron los mismos para ambas técnicas: 0,82 (0,65-0,93) y 0,9 (0,73-0,98), respectivamente. Aunque la diferencia no fue estadísticamente significativa, la sensibilidad fue menor para pacientes con niveles de PSA inferiores: 0,63 vs. 0,89; p = 0,13. Se encontró una correlación significativa entre el SUVmáx de ambos trazadores (r = 0,41, n = 130, p < 0,0001). Conclusiones: La PET/TC con 68Ga-DOTATATE y la PET/TC con 11C-colina parecen poseer alta capacidad de detección de lesiones patológicas en la evaluación de los pacientes con cáncer de próstata en recaída bioquímica. Se necesitan más estudios con el fin de probar el posible valor clínico complementario de estas técnicas PET/TC, y para el 68Ga-DOTATATE para la potencial planificación de terapias mediadas por los receptores de somatostatina (177Lu-DOTATATE)
Background and objectives: To prospectively compare the detection rate of 68Ga-DOTATATE versus 11C-choline PET/CT in patients with prostate cancer in biochemical relapse, and to evaluate somatostatin receptor expression in vivo to plan targeted therapies (177Lu-DOTATATE). Material and methods: We prospectively analysed 64 patients with biochemical relapse (median PSA: 4.25 ng/mL). A PET/CT was performed with 11C-choline, and another with 68Ga-DOTATATE. The SUVmax was measured in all lesions. The correlative images, histopathology and/or clinical and biochemical follow-up were taken as the reference standard. Results: The overall detection rate per patient was 48.43% for 68Ga-DOTATATE and 46.87% for 11C-choline. The results were concordant in 53 cases (82.81%). The maximum SUV of 11C-choline was significantly higher than that of 68Ga-DOTATATE for all the concordant lesions (n=130): 6.17 (1.7-15.5) versus 4.38 (1.37-26.7), median (range) for each radiotracer, respectively (p < .0001). The sensitivity and specificity values per patient were the same for both techniques: 0.82 (0.65-0.93) and 0.9 (0.73-0.98), respectively. Although the difference was not significant, the sensitivity was lower in patients with lower PSA levels: 0.63 vs. 0.89; p=.13. A significant correlation was found between the SUVmax of both tracers (r = 0.41, n = 130, p <.0001). Conclusions: 68Ga-DOTATATE PET/CT and 11C-choline PET/CT seem to have a high capacity to detect pathological lesions in the assessment of patients with prostate cancer with biochemical relapse. Further studies are required to test the potential complementary value of these PET/CT techniques, and to evaluate the potential role of 8Ga-DOTATATE for planning somostatin receptor-mediated therapies (177Lu-DOTATATE)
Subject(s)
Humans , Male , Middle Aged , Aged , Prostatic Neoplasms/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Prostate-Specific Antigen/analysis , Prostatic Neoplasms/pathology , Prospective Studies , Receptors, Somatostatin/analysis , Gadolinium DTPA , Biomarkers, Tumor/analysisABSTRACT
BACKGROUND AND OBJECTIVES: To prospectively compare the detection rate of 68Ga-DOTATATE versus 11C-choline PET/CT in patients with prostate cancer in biochemical relapse, and to evaluate somatostatin receptor expression in vivo to plan targeted therapies (177Lu-DOTATATE). MATERIAL AND METHODS: We prospectively analysed 64 patients with biochemical relapse (median PSA: 4.25 ng/mL). A PET/CT was performed with 11C-choline, and another with 68Ga-DOTATATE. The SUVmax was measured in all lesions. The correlative images, histopathology and/or clinical and biochemical follow-up were taken as the reference standard. RESULTS: The overall detection rate per patient was 48.43% for 68Ga-DOTATATE and 46.87% for 11C-choline. The results were concordant in 53 cases (82.81%). The maximum SUV of 11C-choline was significantly higher than that of 68Ga-DOTATATE for all the concordant lesions (n=130): 6.17 (1.7-15.5) versus 4.38 (1.37-26.7), median (range) for each radiotracer, respectively (p < .0001). The sensitivity and specificity values per patient were the same for both techniques: 0.82 (0.65-0.93) and 0.9 (0.73-0.98), respectively. Although the difference was not significant, the sensitivity was lower in patients with lower PSA levels: 0.63 vs. 0.89; p=.13. A significant correlation was found between the SUVmax of both tracers (r = 0.41, n = 130, p <.0001). CONCLUSIONS: 68Ga-DOTATATE PET/CT and 11C-choline PET/CT seem to have a high capacity to detect pathological lesions in the assessment of patients with prostate cancer with biochemical relapse. Further studies are required to test the potential complementary value of these PET/CT techniques, and to evaluate the potential role of 8Ga-DOTATATE for planning somostatin receptor-mediated therapies (177Lu-DOTATATE).
Subject(s)
Choline/analogs & derivatives , Neoplasm Recurrence, Local/diagnostic imaging , Organometallic Compounds , Positron Emission Tomography Computed Tomography , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/metabolism , Receptors, Somatostatin/biosynthesis , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/blood , Positron Emission Tomography Computed Tomography/methods , Prospective Studies , Prostate-Specific Antigen/blood , Prostatic Neoplasms/bloodABSTRACT
Objetivos. Evaluar la frecuencia de la captación focal de colon como observación incidental en estudios 18F-FDG PET/TC. Correlacionar dicho hallazgo con resultados histopatológicos. Material y métodos. Se analizaron de forma sistemática 30 estudios en los que se constató captación focal del colon de un total de 3.176 PET/TC con 18F-FDG. Se excluyeron pacientes con neoplasia colorrectal conocida. Se consignó el valor del SUV máximo (SUVm) y el hallazgo morfológico de la TC. Los estudios fueron informados por un médico radiólogo y un médico nuclear. Los hallazgos fueron correlacionados con la endoscopia y la anatomía patológica. Resultados. De los 30 pacientes con lesiones focales hipermetabólicas del colon (0,94%), 15 eran hombres y 15 mujeres con edades comprendidas entre los 27 y 73 años (media 55 años). Los motivos de realización de la PET/TC fueron: cáncer broncopulmonar (4), cáncer de mama (4), tumor de origen desconocido (4), melanoma (3), carcinoma renal (3), neoplasia de cuello uterino (2), adenocarcinoma de ovario (2) y otros (8). Se realizaron 23 fibrocolonoscopias (FCC): 10 pacientes (43,4%) presentaron lesiones malignas, 6 pacientes (26,1%) lesiones premalignas y en 7 pacientes (30,4%) no se identificó ninguna lesión o esta fue benigna. En 7 pacientes no se hizo endoscopia por diversos motivos (rechazo del paciente para realizar el estudio, enfermedad oncológica avanzada). Se correlacionó con valores de SUVm y no se encontraron diferencias estadísticamente significativas entre lesiones malignas-premalignas y las lesiones benignas. Conclusiones. La captación focal en colon de 18F-FDG tiene relevancia clínica sobre todo asociada a lesión morfológica en TC, puede tratarse de un segundo tumor o una lesión premaligna. Se recomienda que todas las captaciones focales del colon sean valoradas con endoscopia, tengan o no alteraciones en TC (AU)
Objectives. To assess the frequency of focal colonic uptake as an incidental observation in 18F-FDG PET/CT studies, and to correlate this finding with histopathological results. Material and methods. Out of a total of 3,176 PET/CT studies with 18F-FDG systematic analysis was carried out on 30 studies in which colonic focal uptake was observed. Patients with known colorectal neoplasia were excluded. The maximum standardised uptake values (SUVm) and the morphological findings provided by the CT were recorded. The studies were reported by a radiologist and a nuclear medicine doctor. The findings were compared with endoscopy and pathology findings. Results. Of the 30 patients with focal hypermetabolic lesions of the colon (0.94%), 15 were men and 15 were women with ages between 27 and 73 (mean 55 years). The reasons for PET/CT were bronchopulmonary cancer (4), breast cancer (4), tumour of unknown origin (4), melanoma (3), renal carcinoma (3), cervical neoplasia (2), adenocarcinoma of ovary (2), and others (8). Of the 23 colonoscopies performed, 10 patients (43.4%) had malignant lesions, 6 (26.1%) had pre-malignant lesions, and in 7 patients (30.4%) no lesion was identified or was benign. No endoscopy was performed on 7 patients for various reasons (patient refusal to perform the study, advanced oncological disease). An analysis was performed with the SUVm, with no statistically significant differences being found between malignant-premalignant lesions and benign lesions. Conclusions. Focal uptake in the colon of 18F-FDG has clinical relevance, and is mainly associated with morphological lesions in CT. It should be evaluated, as it may be a second tumour or a pre-malignant lesion. It is recommended that all focal uptakes of the colon be evaluated with endoscopy (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Positron Emission Tomography Computed Tomography/methods , Fluorodeoxyglucose F18 , Colonic Neoplasms/diagnostic imaging , Neoplasms, Second Primary/diagnostic imaging , Incidental Findings , Precancerous Conditions/diagnostic imagingABSTRACT
OBJECTIVES: To assess the frequency of focal colonic uptake as an incidental observation in 18F-FDG PET/CT studies, and to correlate this finding with histopathological results. MATERIAL AND METHODS: Out of a total of 3,176 PET/CT studies with 18F-FDG systematic analysis was carried out on 30 studies in which colonic focal uptake was observed. Patients with known colorectal neoplasia were excluded. The maximum standardised uptake values (SUVm) and the morphological findings provided by the CT were recorded. The studies were reported by a radiologist and a nuclear medicine doctor. The findings were compared with endoscopy and pathology findings. RESULTS: Of the 30 patients with focal hypermetabolic lesions of the colon (0.94%), 15 were men and 15 were women with ages between 27 and 73 (mean 55 years). The reasons for PET/CT were bronchopulmonary cancer (4), breast cancer (4), tumour of unknown origin (4), melanoma (3), renal carcinoma (3), cervical neoplasia (2), adenocarcinoma of ovary (2), and others (8). Of the 23 colonoscopies performed, 10 patients (43.4%) had malignant lesions, 6 (26.1%) had pre-malignant lesions, and in 7 patients (30.4%) no lesion was identified or was benign. No endoscopy was performed on 7 patients for various reasons (patient refusal to perform the study, advanced oncological disease). An analysis was performed with the SUVm, with no statistically significant differences being found between malignant-premalignant lesions and benign lesions. CONCLUSIONS: Focal uptake in the colon of 18F-FDG has clinical relevance, and is mainly associated with morphological lesions in CT. It should be evaluated, as it may be a second tumour or a pre-malignant lesion. It is recommended that all focal uptakes of the colon be evaluated with endoscopy.
