Robot-Assisted Prostate-Specific Membrane Antigen-Radioguided Surgery in Primary Diagnosed Prostate Cancer

被引:42
作者
Gondoputro, William [1 ,2 ,3 ,4 ]
Scheltema, Matthijs J. [1 ,2 ,3 ]
Blazevski, Alexander [1 ,2 ,3 ,4 ]
Doan, Paul [1 ,2 ,3 ,4 ]
Thompson, James E. [1 ,2 ,3 ,4 ]
Amin, Amer [1 ,2 ,3 ,4 ]
Geboers, Bart [1 ,2 ,3 ]
Agrawal, Shikha [1 ,2 ]
Siriwardana, Amila [1 ,2 ,3 ]
Van Leeuwen, Pim J. [5 ]
Van Oosterom, Matthias N. [5 ,6 ]
Van Leeuwen, Fijs W. B. [5 ,6 ]
Emmett, Louise [1 ,2 ,4 ,7 ]
Stricker, Phillip D. [1 ,2 ,3 ,4 ]
机构
[1] Garvan Inst Med Res, Darlinghurst, NSW, Australia
[2] Kinghorn Canc Ctr, Darlinghurst, NSW, Australia
[3] St Vincents Prostate Canc Res Ctr, Darlinghurst, NSW, Australia
[4] Univ New South Wales, St Vincents Clin Sch, Sydney, Australia
[5] Antoni Van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Urol, Amsterdam, Netherlands
[6] Leiden Univ, Dept Radiol, Intervent Mol Imaging Lab, Med Ctr, Leiden, Netherlands
[7] St Vincents Hosp Sydney, Dept Theranost & Nucl Med, Darlinghurst, NSW, Australia
关键词
image-guided surgery; prostate-specific membrane antigen; prostate cancer; robot-assisted surgery; extended pelvic lymph node dissection; LYMPH-NODE DISSECTION; RADICAL PROSTATECTOMY;
D O I
10.2967/jnumed.121.263743
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
The objective of this study was to evaluate the safety and feasibility of 99mTc-based prostate-specific membrane antigen (PSMA) robotassisted-radioguided surgery to aid or improve the intraoperative detection of lymph node metastases during primary robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa). Methods: Men with primary high-risk PCa (>= cT3a, International Society of Urological Pathology (ISUP) grade group >= 3 or prostate-specific antigen of >= 15 ng/mL) with potential lymph node metastasis (Briganti nomogram risk. 10% or on preoperative imaging) were enrolled in the study. Patients underwent staging Ga-68-PSMA PET/CT scanning. Preoperatively, a Tc-99m-labeled PSMA ligand (Tc-99m PSMA I & S; 500 MBq) was administered followed by SPECT/CT. A RARP including extended pelvic lymph node dissection was performed, with intraoperative tracing of PSMA-avid tissues using a prototype DROP-IN g-probe. Resected specimens were also measured ex vivo. Histopathologic concordance with probe findings was evaluated. A radiotracer count of >= 1.5 times the background reference (in vivo), and >= 10 (absolute count) in the ex vivo setting, was considered positive. Results: Twelve patients were included (median age, 68 y, and prostate-specific antigen, 9.15 ng/mL). Most of the patients harbored ISUP 5 PCa (75%) and had avid lymph nodes on preoperative PSMA PET (64%). The DROP-IN probe aided resection of PSMA-avid (out-of-template) lymph nodes and residual disease at the prostate bed. Eleven metastatic lymph nodes were identified by the probe that were not observed on preoperative 68Ga-PSMA PET/CT. Of the 74 extraprostatic tissue specimens that were resected, 22 (29.7%) contained PCa. The sensitivity, specificity, positive predictive value, and negative predictive value of inpatient use of the g-probe were 76% (95% CI, 53%-92%), 69% (95% CI, 55%-81%), 50%, and 88%, respectively. Ex vivo, the diagnostic accuracy was superior: 76% (95% CI, 53%-92%), 96% (95% CI, 87%-99%), 89%, and 91%, respectively, for sensitivity, specificity, positive predictive value, and negative predictive value. Of the missed lymph nodes in vivo (n 5 5) and ex vivo (n 5 5), 90% were micrometastasis (#3 mm). No complications greater than Clavien-Dindo Grade I occurred. Conclusion: Robot-assisted 99mTc-based PSMA-radioguided surgery is feasible and safe in the primary setting, optimizing the detection of nodal metastases at the time of RARP and extended pelvic lymph node dissection. Further improvement of the detector technology may optimize the capabilities of robot-assisted 99mTcbased PSMA-radioguided surgery.
引用
收藏
页码:1659 / 1664
页数:6
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