A Voice From the Past: Rediscovering the Virchow Node With Prostate-specific Membrane Antigen-targeted 18 F-DCFPyL Positron Emission Tomography Imaging

Werner, Rudolf A.; Andreé, Christian; Javadi, Mehrbod S.; Lapa, Constantin; Buck, Andreas K.; Higuchi, Takahiro; Pomper, Martin G.; Gorin, Michael A.; Rowe, Steven P.; Pienta, Kenneth J.

doi:10.1016/j.urology.2018.03.030

Cited by 21 publications

(17 citation statements)

References 20 publications

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“…2), a surprisingly high rate for this site. Thus, PSMA PET/ CT now reveals involvement of the left supraclavicular node in a substantial fraction of patients, as has been previously documented (18). We found that metastases in the Virchow lymph nodes were significantly more frequent (0.002) for primary tumors with a GS of 8 or higher than for those with a GS of 7b or lower.…”

Section: Discussionsupporting

confidence: 85%

“…Moreover, new diagnostic imaging such as multiparametric MRI and prostate-specific membrane antigen (PSMA) PET/CT increases the accuracy of staging before irradiation. In particular, PSMA PET/CT imaging has reported sensitivity and specificity of up to 80% and 95%, respectively, for prostate cancer and is well suited for assessing the detection of nodal metastases-even compared with 18 F-fluorocholine PET/CT (7)(8)(9)(10)(11). For detection of nodal metastases, a sensitivity of 84% and a specificity of 82% were observed for PSMA imaging (12).…”

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confidence: 99%

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Lymph Node Involvement in Treatment-Naïve Prostate Cancer Patients: Correlation of PSMA PET/CT Imaging and Roach Formula in 280 Men in Radiotherapeutic Management

et al. 2019

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Section: Discussionsupporting

confidence: 85%

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confidence: 99%

Lymph Node Involvement in Treatment-Naïve Prostate Cancer Patients: Correlation of PSMA PET/CT Imaging and Roach Formula in 280 Men in Radiotherapeutic Management

et al. 2019

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“…In light of the growing availability of 68 Ga-or 18 F-labeled PSMA-targeted imaging agents (19)(20)(21)(22), the number of molecular imaging specialists that routinely interpret PET scans with these compounds outside controlled clinical trials is expanding (23). However, numerous studies have reported pitfalls in the reading of PSMA-targeted PET studies, including studies of Paget disease, sarcoidosis, or nervous tissue such as ganglia (7-10).…”

Section: Discussionmentioning

confidence: 99%

Interobserver Agreement for the Standardized Reporting System PSMA-RADS 1.0 on ¹⁸F-DCFPyL PET/CT Imaging

Werner

Bundschuh²,

Bundschuh³

et al. 2018

J Nucl Med

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Recently, the standardized reporting and data system for prostate-specific membrane antigen (PSMA)-targeted PET imaging studies, termed PSMA-RADS version 1.0, was introduced. We aimed to determine the interobserver agreement for applying PSMA-RADS to imaging interpretation of F-DCFPyL (2-(3-{1-carboxy-5-[(6-F-fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid) PET examinations in a prospective setting mimicking the typical clinical workflow at a prostate cancer referral center. Four readers (2 experienced readers (ERs,>3 y of PSMA-targeted PET interpretation experience) and 2 inexperienced readers (IRs, <1 y of experience)), who had all read the initial publication on PSMA-RADS 1.0, assessed 50 F-DCFPyL PET/CT studies independently. Per scan, a maximum of 5 target lesions was selected by the observers, and a PSMA-RADS score for every target lesion was recorded. No specific preexisting conditions were placed on the selection of the target lesions, although PSMA-RADS 1.0 suggests that readers focus on the most avid or largest lesions. An overall scan impression based on PSMA-RADS was indicated, and interobserver agreement rates on a target lesion-based, on an organ-based, and on an overall PSMA-RADS score-based level were computed. The number of target lesions identified by each observer was as follows: ER 1, 123; ER 2, 134; IR 1, 123; and IR 2, 120. Among those selected target lesions, 125 were chosen by at least 2 individual observers (all 4 readers selected the same target lesion in 58 of 125 [46.4%] instances, 3 readers in 40 of 125 [32%], and 2 observers in 27 of 125 [21.6%]). The interobserver agreement for PSMA-RADS scoring among identical target lesions was good (intraclass correlation coefficient [ICC] for 4, 3, and 2 identical target lesions, ≥0.60, respectively). For lymph nodes, an excellent interobserver agreement was derived (ICC, 0.79). The interobserver agreement for an overall scan impression based on PSMA-RADS was also excellent (ICC, 0.84), with a significant difference for ER (ICC, 0.97) vs. IR (ICC, 0.74) ( = 0.005). PSMA-RADS demonstrated a high concordance rate in this study, even among readers with different levels of experience. This finding suggests that PSMA-RADS can be effectively used for communication with clinicians and can be implemented in the collection of data for large prospective trials.

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“…The reviewers reached a consensus on all lesions included in the analysis. As had previously been set forth in the original PSMA-RADS article (16), the central reviewers considered PSMA-RADS-3A lesions to be those LNs or soft-tissue findings that had subtle radiotracer uptake (approximately blood pool or slightly higher) and that were in a typical pattern of distribution for PCa (e.g., pelvis and retroperitoneum, as well as mediastinum and left supraclavicular space in patients with more advanced disease (22)). PSMA-RADS-3B lesions could generally be described as sites of lowlevel uptake in the bone without an appreciable anatomic correlate or with punctate sclerosis or other findings on corresponding CT that did not definitively suggest the presence of metastatic disease.…”

Section: Image Analysismentioning

confidence: 99%

Follow-up of Lesions with Equivocal Radiotracer Uptake on PSMA-Targeted PET in Patients with Prostate Cancer: Predictive Values of the PSMA-RADS-3A and PSMA-RADS-3B Categories

et al. 2018

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Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) imaging has become commonly utilized in patients with prostate cancer (PCa). The PSMA reporting and data system version 1.0 (PSMA-RADS version 1.0) categorizes lesions on the basis of the likelihood of PCa involvement, with PSMA-RADS-3A (soft tissue) and PSMA-RADS-3B (bone) lesions being indeterminate for the presence of disease. We retrospectively reviewed the imaging follow-up of such lesions to determine the rate at which they underwent changes suggestive of underlying PCa. PET/CT imaging withF-DCFPyL was carried out in 110 patients with PCa and lesions were categorized according to PSMA-RADS Version 1.0. 56/110 (50.9%) patients were determined to have indeterminate PSMA-RADS-3A or PSMA-RADS-3B lesions and 22/56 (39.3%) patients had adequate follow-up to be included in the analysis. The maximum standardized uptake values (SUV) of the lesions were obtained and the ratios of SUV of the lesions to SUVmean of blood pool (SUV-lesion/SUVmean-bloodpool) were calculated. Pre-determined criteria were used to evaluate the PSMA-RADS-3A and PSMA-RADS-3B lesions on follow-up imaging to determine if they demonstrated evidence of underlying malignancy. A total of 46 lesions in 22 patients were considered indeterminate for PCa (i.e. PSMA-RADS-3A (32 lesions) or PSMA-RADS-3B (14 lesions)) and were evaluable on follow-up imaging. 27/46 (58.7%) lesions demonstrated changes on follow-up imaging consistent with the presence of underlying PCa at baseline. These lesions included 24/32 (75.0%) PSMA-RADS-3A lesions and 3/14 (21.4%) lesions categorized as PSMA-RADS-3B. The ranges of SUV and SUV-lesion/SUVmean-bloodpool overlapped between those lesions demonstrating changes consistent with malignancy on follow-up imaging and those lesions that remained unchanged on follow-up. PSMA-RADS-3A and PSMA-RADS-3B lesions are truly indeterminate in that proportions of findings in both categories demonstrate evidence of malignancy on follow-up imaging. Overall, PSMA-RADS-3A lesions are more likely than PSMA-RADS-3B lesions to represent sites of PCa and this information should be taken into account when guiding patient therapy.

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A Voice From the Past: Rediscovering the Virchow Node With Prostate-specific Membrane Antigen-targeted 18 F-DCFPyL Positron Emission Tomography Imaging

Cited by 21 publications

References 20 publications

Lymph Node Involvement in Treatment-Naïve Prostate Cancer Patients: Correlation of PSMA PET/CT Imaging and Roach Formula in 280 Men in Radiotherapeutic Management

Lymph Node Involvement in Treatment-Naïve Prostate Cancer Patients: Correlation of PSMA PET/CT Imaging and Roach Formula in 280 Men in Radiotherapeutic Management

Interobserver Agreement for the Standardized Reporting System PSMA-RADS 1.0 on ¹⁸F-DCFPyL PET/CT Imaging

Follow-up of Lesions with Equivocal Radiotracer Uptake on PSMA-Targeted PET in Patients with Prostate Cancer: Predictive Values of the PSMA-RADS-3A and PSMA-RADS-3B Categories

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A Voice From the Past: Rediscovering the Virchow Node With Prostate-specific Membrane Antigen-targeted 18 F-DCFPyL Positron Emission Tomography Imaging

Cited by 21 publications

References 20 publications

Lymph Node Involvement in Treatment-Naïve Prostate Cancer Patients: Correlation of PSMA PET/CT Imaging and Roach Formula in 280 Men in Radiotherapeutic Management

Lymph Node Involvement in Treatment-Naïve Prostate Cancer Patients: Correlation of PSMA PET/CT Imaging and Roach Formula in 280 Men in Radiotherapeutic Management

Interobserver Agreement for the Standardized Reporting System PSMA-RADS 1.0 on 18F-DCFPyL PET/CT Imaging

Follow-up of Lesions with Equivocal Radiotracer Uptake on PSMA-Targeted PET in Patients with Prostate Cancer: Predictive Values of the PSMA-RADS-3A and PSMA-RADS-3B Categories

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Interobserver Agreement for the Standardized Reporting System PSMA-RADS 1.0 on ¹⁸F-DCFPyL PET/CT Imaging