Preoperative staging of pelvic lymph nodes in prostate cancer by 11C-choline PET.
Prostate cancer is known for its difficulties in preoperative staging of pelvic lymph nodes by conventional imaging techniques. Thus, a histopathologic examination of the pelvic lymphadenectomy specimen is mandatory for patients at risk for metastatic disease. The aim of this study was to evaluate the strength and accuracy of (11)C-choline PET in preoperative noninvasive staging of pelvic lymph nodes in prostate cancer.


METHODS
In a prospective study we examined 67 consecutive patients with histologically proven prostate cancer with (11)C-choline PET. The results of PET were compared with the results of histology of the pelvic lymph nodes and with the follow-up data. Conventional axial imaging was routinely performed using MRI or CT. The sensitivity, specificity, and accuracy of (11)C-choline PET were calculated.


RESULTS
Fifteen patients had histologically proven lymph node metastases. (11)C-Choline PET was true-positive in 12 of 15 patients and false-negative in 3 patients. Fifty-two patients had no lymph node metastases. (11)C-Choline PET was true-negative in 50 of 52 patients and false-positive in 2 patients. We calculated a sensitivity of (11)C-choline PET for staging metastatic lymph node disease of 80%, a specificity of 96%, and an accuracy of 93%. Next, (11)C-choline PET detected solitary extraregional lymph node metastases in 5 of 12 patients with nodal metastases.


CONCLUSIONS
This study showed that (11)C-choline PET is sensitive and accurate in preoperative staging of pelvic lymph nodes in prostate cancer.
de Jong
Igle J
IJ
Department of Urology and PET Center, Groningen University Hospital, Groningen, The Netherlands. i.j.de.jong@chir.azu.nl
Pruim
Jan
J
Elsinga
Philip H
PH
Vaalburg
Willem
W
Mensink
Han J
HJ
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000368:Aged; D002250:Carbon Radioisotopes; D002794:Choline; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed
D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D002794:Choline