对于在磁共振成像(MRI)检查中出现前列腺成像报告和数据系统(PI-RADS)3/4发现的患者,标准建议通常包括进行活检以进行病理评估,以确定病变的性质。这一行动方针,尽管对于准确诊断至关重要,总是会放大患者所经历的心理困扰,并引入许多与活检程序相关的潜在并发症。然而,[18F]DCFPyLPET/CT成像成为一种有前途的替代方案,在辨别良性前列腺病变和恶性前列腺病变方面表现出相当大的诊断功效。本研究旨在探讨[18F]DCFPyLPET/CT显像对前列腺癌患者PI-RADS3/4病灶的诊断价值,协助临床决策,以避免不必要的活检。30例通过mpMRI诊断为PI-RADS3/4病变的患者接受[18F]DCFPyLPET/CT成像,以最终活检病理结果作为“参考标准”。通过受试者工作特性(ROC)分析评估诊断性能,在[18F]DCFPyLPET/CT成像中评估分子影像学PSMA(miPSMA)视觉分析和半定量分析的诊断效能。根据前列腺癌分子影像学标准化评估标准对病变进行miPSMA评分。在30名患者中,13例经病理证实为前列腺癌。敏感性,特异性,正预测值,负预测值,视觉分析[18F]DCFPyLPET/CT显像诊断PI-RADS3/4病灶的准确率为61.5%,88.2%,80.0%,75.0%,76.5%,分别。使用SUVmax4.17作为最佳阈值,灵敏度,特异性,正预测值,负预测值,诊断准确率为92.3%,88.2%,85.7%,93.8%,90.0%,分别。半定量分析的ROC曲线下面积(AUC)为0.94,明显高于视觉分析的0.80。[18F]DCFPyLPET/CT显像在15例(50%)PI-RADS3/4患者中准确诊断良性病变。对于PI-RADS4病变的患者,[18F]DCFPyLPET/CT显像的阳性预测值达到100%。[18F]DCFPyLPET/CT成像提供了对mpMRIPI-RADS3/4患者的病变性质的潜在术前预测,这可能有助于治疗决策和减少不必要的活检。
For patients presenting with prostate imaging reporting and data system (PI-RADS) 3/4 findings on magnetic resonance imaging (MRI) examinations, the standard recommendation typically involves undergoing a biopsy for pathological assessment to ascertain the nature of the lesion. This course of action, though essential for accurate diagnosis, invariably amplifies the psychological distress experienced by patients and introduces a host of potential complications associated with the biopsy procedure. However, [18F]DCFPyL PET/CT imaging emerges as a promising alternative, demonstrating considerable diagnostic efficacy in discerning benign prostate lesions from malignant ones. This study aims to explore the diagnostic value of [18F]DCFPyL PET/CT imaging for prostate cancer in patients with PI-RADS 3/4 lesions, assisting in clinical decision-making to avoid unnecessary biopsies. 30 patients diagnosed with PI-RADS 3/4 lesions through
mpMRI underwent [18F]DCFPyL PET/CT imaging, with final biopsy pathology results as the \"reference standard\". Diagnostic performance was assessed through receiver operating characteristic (ROC) analysis, evaluating the diagnostic efficacy of molecular imaging PSMA (miPSMA) visual analysis and semi-quantitative analysis in [18F]DCFPyL PET/CT imaging. Lesions were assigned miPSMA scores according to the prostate cancer molecular imaging standardized evaluation criteria. Among the 30 patients, 13 were pathologically confirmed to have prostate cancer. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of visual analysis in [18F]DCFPyL PET/CT imaging for diagnosing PI-RADS 3/4 lesions were 61.5%, 88.2%, 80.0%, 75.0%, and 76.5%, respectively. Using SUVmax 4.17 as the optimal threshold, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis were 92.3%, 88.2%, 85.7%, 93.8%, and 90.0%, respectively. The area under the ROC curve (AUC) for semi-quantitative analysis was 0.94, significantly higher than visual analysis at 0.80. [18F]DCFPyL PET/CT imaging accurately diagnosed benign lesions in 15 (50%) of the PI-RADS 3/4 patients. For patients with PI-RADS 4 lesions, the positive predictive value of [18F]DCFPyL PET/CT imaging reached 100%. [18F]DCFPyL PET/CT imaging provides potential preoperative prediction of lesion nature in
mpMRI PI-RADS 3/4 patients, which may aid in treatment decision-making and reducing unnecessary biopsies.