Composite Prediction Score to Interpret Bone Focal Uptake in Hormone-Sensitive Prostate Cancer Patients Imaged with [ 18 F]PSMA-1007 PET/CT.

Autor: Bauckneht M; Department of Health Sciences, University of Genova, Genova, Italy; matteo.bauckneht@unige.it.; Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy., D'Amico F; Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy., Albano D; Nuclear Medicine, ASST Spedali Civili di Brescia, Brescia, Italy.; University of Brescia, Brescia, Italy., Balma M; Nuclear Medicine, S. Croce e Carle Hospital, Cuneo, Italy., Cabrini C; Department of Health Sciences, University of Genova, Genova, Italy., Dondi F; Nuclear Medicine, ASST Spedali Civili di Brescia, Brescia, Italy.; University of Brescia, Brescia, Italy., Di Raimondo T; Department of Health Sciences, University of Genova, Genova, Italy., Liberini V; Nuclear Medicine, S. Croce e Carle Hospital, Cuneo, Italy., Sofia L; Department of Health Sciences, University of Genova, Genova, Italy., Peano S; Nuclear Medicine, S. Croce e Carle Hospital, Cuneo, Italy., Riondato M; Department of Health Sciences, University of Genova, Genova, Italy.; Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy., Fornarini G; Medical Oncology 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy., Laudicella R; Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy., Carmisciano L; Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy., Lopci E; Nuclear Medicine, IRCCS, Humanitas Research Hospital, Rozzano, Italy., Zanca R; Nuclear Medicine, IRCCS, Humanitas Research Hospital, Rozzano, Italy., Rodari M; Nuclear Medicine, IRCCS, Humanitas Research Hospital, Rozzano, Italy., Raffa S; Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy., Donegani MI; Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy., Dubois D; Department of Health Sciences, University of Genova, Genova, Italy., Peñuela L; Department of Health Sciences, University of Genova, Genova, Italy., Marini C; Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy.; Institute of Molecular Bioimaging and Physiology, National Research Council, Milan, Italy., Bertagna F; Nuclear Medicine, ASST Spedali Civili di Brescia, Brescia, Italy.; University of Brescia, Brescia, Italy., Papaleo A; Nuclear Medicine, S. Croce e Carle Hospital, Cuneo, Italy., Morbelli S; Nuclear Medicine, AOU Città della Salute e della Scienza, Turin, Italy; and.; Department of Medical Sciences, University of Turin, Turin, Italy., Sambuceti G; Department of Health Sciences, University of Genova, Genova, Italy.; Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy., Ponzano M; Department of Health Sciences, University of Genova, Genova, Italy., Signori A; Department of Health Sciences, University of Genova, Genova, Italy.
Jazyk: angličtina
Zdroj: Journal of nuclear medicine : official publication, Society of Nuclear Medicine [J Nucl Med] 2024 Oct 01; Vol. 65 (10), pp. 1577-1583. Date of Electronic Publication: 2024 Oct 01.
DOI: 10.2967/jnumed.124.267751
Abstrakt: Unspecific bone uptake (UBU) related to [ 18 F]PSMA-1007 PET/CT imaging represents a clinical challenge. We aimed to assess whether a combination of clinical, biochemical, and imaging parameters could predict skeletal metastases in patients with [ 18 F]PSMA-1007 bone focal uptake, aiding in result interpretation. Methods: We retrospectively analyzed [ 18 F]PSMA-1007 PET/CT performed in hormone-sensitive prostate cancer (PCa) patients at 3 tertiary-level cancer centers. A fourth center was involved in performing an external validation. For each, a volume of interest was drawn using a threshold method to extract SUV max , SUV mean , PSMA tumor volume, and total lesion PSMA. The same volume of interest was applied to CT images to calculate the mean Hounsfield units (HU mean ) and maximum Hounsfield units. Clinical and laboratory data were collected from electronic medical records. A composite reference standard, including follow-up histopathology, biochemistry, and imaging data, was used to distinguish between PCa bone metastases and UBU. PET readers with less ( n = 2) or more ( n = 2) experience, masked to the reference standard, were asked to visually rate a subset of focal bone uptake ( n = 178) as PCa metastases or not. Results: In total, 448 bone [ 18 F]PSMA-1007 focal uptake specimens were identified in 267 PCa patients. Of the 448 uptake samples, 188 (41.9%) corresponded to PCa metastases. Ongoing androgen deprivation therapy at PET/CT ( P < 0.001) with determination of SUV max ( P < 0.001) and HU mean ( P < 0.001) independently predicted bone metastases. A composite prediction score, the bone uptake metastatic probability (BUMP) score, achieving an area under the receiver-operating-characteristic curve (AUC) of 0.87, was validated through a 10-fold internal and external validation ( n = 89 bone uptake, 51% metastatic; AUC, 0.92). The BUMP score's AUC was significantly higher than that of HU mean (AUC, 0.62) and remained high among lesions with HU mean in the first tertile (AUC, 0.80). A decision-curve analysis showed a higher net benefit with the score. Compared with the visual assessment, the BUMP score provided added value in terms of specificity in less-experienced PET readers (88% vs. 54%, P < 0.001). Conclusion: The BUMP score accurately distinguished UBU from bone metastases in PCa patients with [ 18 F]PSMA-1007 focal bone uptake at PET imaging, offering additional value compared with the simple assessment of the osteoblastic CT correlate. Its use could help clinicians interpret imaging results, particularly those with less experience, potentially reducing the risk of patient overstaging.
(© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)
Databáze: MEDLINE
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