title: Prospective evaluation of 11C-choline positron emission tomography/computed tomography and diffusion-weighted magnetic resonance imaging for the nodal staging of prostate cancer with a high risk of lymph node metastases.
abstract: BACKGROUND
  Contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging for lymph node (LN) staging of prostate cancer (PCa) are largely inadequate.
  
  
  OBJECTIVE
  Our aim was to assess prospectively the sensitivity, specificity, and positive and negative predictive values for the LN staging by (11)C-choline positron emission tomography (PET)-CT and MR diffusion-weighted imaging (DWI) of the pelvis before retropubic radical prostatectomy (RRP) with extended pelvic LN dissection (PLND).
  
  
  METHODS
  From February 2008 to August 2009, 36 patients with histologically proven PCa and no pelvic LN involvement on contrast-enhanced CT with a risk ≥ 10% but ≤ 35% at LN metastasis according to the Partin tables were enrolled in this study.
  
  
  METHODS
  Patients preoperatively underwent (11)C-choline PET-CT and DWI. Subsequently all patients underwent a wide RRP and an extended PLND.
  
  
  METHODS
  Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for LN status of (11)C-choline PET-CT and DWI were calculated with the final histopathology of the LNs as comparator.
  
  
  CONCLUSIONS
  Seventeen patients (47%) had a pN1 stage, and 38 positive LNs were identified. On a LN region-based analysis, sensitivity, specificity, PPV, NPV, and the number of correctly recognised cases at (11)C-choline PET-CT were 9.4%, 99.7%, 75.0%, 91.0%, and 7.9%, respectively, and at DWI these numbers were 18.8%, 97.6%, 46.2%, 91.7%, and 15.8%, respectively. Twelve LN regions containing macrometastases, of which 2 had capsular penetration, were not detected by (11)C-choline PET-CT; 11 LNs, of which 2 had capsular penetration, were not detected by DWI. This is a small study with 36 patients, but we intend to recruit more patients.
  
  
  CONCLUSIONS
  From this prospective histopathology-based evaluation of (11)C-choline PET-CT and DWI for LN staging in high-risk PCa patients, it is concluded that these techniques cannot be recommended at present to detect occult LN metastases before initial treatment.
authors.affiliation: Department of Radiation Oncology, UH Leuven, Leuvens Kanker Instituut, Leuven, Belgium. tombudiharto@uz.kuleuven.ac.be
authors.forename: Tom
authors.initials: T
authors.lastname: Budiharto
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
authors.forename: Evelyne
authors.initials: E
authors.lastname: Lerut
authors.forename: Laura
authors.initials: L
authors.lastname: Van den Bergh
authors.forename: Felix
authors.initials: F
authors.lastname: Mottaghy
authors.forename: Christophe M
authors.initials: CM
authors.lastname: Deroose
authors.forename: Raymond
authors.initials: R
authors.lastname: Oyen
authors.forename: Filip
authors.initials: F
authors.lastname: Ameye
authors.forename: Kris
authors.initials: K
authors.lastname: Bogaerts
authors.forename: Karin
authors.initials: K
authors.lastname: Haustermans
authors.forename: Hendrik
authors.initials: H
authors.lastname: Van Poppel
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D002250:Carbon Radioisotopes; D002794:Choline; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D002250:Carbon Radioisotopes; D002794:Choline