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False positive PSMA PET for tumor remnants in the irradiated prostate and other interpretation pitfalls in a prospective multi-center trial.
- Source :
- European Journal of Nuclear Medicine & Molecular Imaging; 2021, Vol. 48 Issue 2, p501-508, 8p, 3 Color Photographs, 1 Chart
- Publication Year :
- 2021
-
Abstract
- Purpose: Readers need to be informed about potential pitfalls of [<superscript>68</superscript>Ga]Ga-PSMA-11 PET interpretation. Methods: Here we report [<superscript>68</superscript>Ga]Ga-PSMA-11 PET findings discordant with the histopathology/composite reference standard in a recently published prospective trial on 635 patients with biochemically recurrent prostate cancer. Results: Consensus reads were false positive in 20 regions of 17/217 (8%) patients with lesion validation. Majority of the false positive interpretations (13 of 20, 65%) occurred in the context of suspected prostate (bed) relapse (T) after radiotherapy (n = 11); other false positive findings were noted for prostate bed post prostatectomy (T, n = 2), pelvic nodes (N, n = 2), or extra pelvic lesions (M, n = 5). Major sources of false positive findings were PSMA-expressing residual adenocarcinoma with marked post-radiotherapy treatment effect. False negative interpretation occurred in 8 regions of 6/79 (8%) patients with histopathology validation, including prostate (bed) (n = 5), pelvic nodes (n = 1), and extra pelvic lesions (n = 2). Lesions were missed mostly due to small metastases or adjacent bladder/urine uptake. Conclusion: [<superscript>68</superscript>Ga]Ga-PSMA-11 PET at biochemical recurrence resulted in less than 10% false positive interpretations. Post-radiotherapy prostate uptake was a major source of [<superscript>68</superscript>Ga]Ga-PSMA-11 PET false positivity. In few cases, PET correctly detects residual PSMA expression post-radiotherapy, originating however from treated, benign tissue or potentially indolent tumor remnants. Trial registration number: ClinicalTrials.gov Identifiers: NCT02940262 and NCT03353740. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 16197070
- Volume :
- 48
- Issue :
- 2
- Database :
- Complementary Index
- Journal :
- European Journal of Nuclear Medicine & Molecular Imaging
- Publication Type :
- Academic Journal
- Accession number :
- 148321578
- Full Text :
- https://doi.org/10.1007/s00259-020-04945-1