Prostate-Specific Membrane Antigen (PSMA) PET/CT in the Detection and Diagnosis of Hepatocellular Carcinoma (HCC): A Systematic Review and Meta-Analysis.

Simple Summary: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death world-wide. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is a novel imaging modality used in prostate cancer that appears to demonstrate uptake in HCC. The aim of this systematic review and meta-analysis was to determine the sensitivity and specificity of PSMA PET for HCC. On systematic review, 68Ga-PSMA-11 demonstrated a high sensitivity on per-patient analysis for HCC, 89.9% (95% CI 78.5–95.5), and on a per-lesion analysis, this increased to 94.5% (95% CI 82.9–98.4). Specificity, however, was poorly reported, with insufficient data for analysis. The meta-analysis of studies with sufficient data demonstrated a sensitivity of 97.1% (95% CI 87.8–99.4) and specificity of 42.2% (95% CI 0.3–99.4) on per-lesion level for HCC. Specificity has been poorly reported, and diagnostic accuracy remains unclear. Further prospective studies are required to define the true specificity of PSMA PET for HCC. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is widely used in prostate cancer. Recent studies indicate hepatocellular carcinoma (HCC) demonstrates PSMA PET uptake. The diagnostic accuracy of PSMA PET for HCC is not known. We conducted a systematic review and meta-analysis of studies assessing 68Ga-PSMA-11 in HCC. Nine studies were included, with 196 patients and a total of 491 HCC lesions. Per-patient analysis yielded a pooled sensitivity of 89.8% (95% CI 78.5–95.5). Specificity was poorly reported, with insufficient data. When per-lesion level analysis was performed on seven studies, the pooled sensitivity was 94.5% (95% CI 82.9–98.4), and specificity was again poorly reported with insufficient data. Among the three studies with adequate data for full per-lesion meta-analysis, 115 lesions in 41 patients demonstrated sensitivity of 97.1% (95% CI 87.8–99.4), while specificity was 42.2% (95% CI 0.3–99.4). Two studies provided sufficient data for meta-analysis on a per-patient level (n = 50 patients), demonstrating a sensitivity of 92.5% (95% CI 64.0–98.9) and specificity of 72.4% (95% CI 1.3–99.8). PSMA PET demonstrates a high sensitivity for HCC and shows promise as an imaging modality for diagnosis and staging of HCC. However, the existing literature does not provide enough data to confidently evaluate its specificity and, therefore, accuracy. Further prospective studies are necessary, with a focus on the accurate reporting of benign lesions and inclusion of patients with an intermediate probability of HCC. [ABSTRACT FROM AUTHOR]