Diagnostics (Basel, Switzerland) · 2025
An Evaluation of the Diagnostic Accuracy of [68Ga]Ga-PSMA-11 vs. [18F]F-PSMA-1007 PET/CT for Lymph Node Staging in Patient Candidates for Radical Prostatectomy and Lymph Node Dissection: A Single Institutional Analysis.
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Arena Paola, Fasulo Vittorio, Gelardi Fabrizia, Frego Nicola, Jandric Jelena, Maffei Davide, Avolio Pier Paolo, Paciotti Marco, Chiarelli Giuseppe, De Carne Fabio, Dagnino Filippo, Piccolini Andrea, Lopci Egesta, Hurle Rodolfo, Saita Alberto, Chiti Arturo, Lazzeri Massimo, Evangelista Laura, Buffi Nicolò Maria, Casale Paolo, Lughezzani Giovanni
Аннотация
Background/Objectives: This study evaluates and compares the diagnostic accuracy of [68Ga]Ga-PSMA-11 and [18F]F-PSMA-1007 for lymph node staging in patients with prostate cancer (PCa) scheduled for robot-assisted radical prostatectomy (RARP) and lymphadenectomy (LND). Methods: We retrospectively reviewed prospectively collected data on patients referred to our hospital from October 2020 to January 2023. We included all patients who underwent [68Ga]Ga-PSMA-11 or [18F]F-PSMA-1007 PET/CT for primary staging and subsequently had RARP with concomitant LND. The maximum standard uptake value (SUVmax) for lymph nodes (LNs) and the SUV node-to-background ratio were reported. Two different cut-off values for the SUV node-to-background ratio (i.e., ≥2 vs. <2 and ≥15.5 vs. <15.5) were used to evaluate the diagnostic performance of both tracers. The first cut-off was empirically chosen, while the second was based on Liu's method. Results: A total of 156 patients were included (median age: 67 years). Among them, 83 underwent [68Ga]Ga-PSMA-11 and 73 underwent [18F]F-PSMA-1007 PET/CT. Suspicious lymph nodes were identified in 21 patients (13.5%). Pathological nodal involvement (pN1) was confirmed in 25 cases (16%). Of the 21 patients with suspicious pathological lymph nodes on PSMA PET/CT, 9 (42.9%) had positive nodes on the final pathology report. With an SUV node-to-background ratio cut-off of ≥2, [68Ga]Ga-PSMA-11 showed 37.5% sensitivity (SE) and 98.5% specificity(SP), while [18F]F-PSMA-1007 demonstrated 33.3% SE and 100% SP. Using the ≥15.5 cut-off, SE and SP were 31.3% and 100% for [68Ga]Ga-PSMA-11 and 11.1% and 100% for [18F]F-PSMA-1007, respectively. Conclusions: [18F]F-PSMA-1007 PET/CT showed, even if not statistically significantly, slightly lower SE and higher SP for nodal staging compared to [68Ga]Ga-PSMA-11 PET/CT, irrespective of the SUV ratio used.