title: Detection of lymph node metastasis in patients with nodal prostate cancer relapse using (18)F/(11)C-choline positron emission tomography/computerized tomography.
abstract: OBJECTIVE
  We evaluated the diagnostic accuracy of choline positron emission tomography/computerized tomography for nodal relapse of prostate cancer according to topographical site and tumor infiltration size in lymph nodes.
  
  
  METHODS
  A total of 72 patients with nodal prostate cancer relapse after primary therapy underwent pelvic and/or retroperitoneal salvage lymph node dissection. Salvage was done after whole body positron emission tomography/computerized tomography with (11)C-choline or (18)F-fluoroethylcholine showed positron emission tomography positive lymph nodes but no other detectable metastasis. Diagnostic accuracy was evaluated in 160 dissected lymph node regions (pelvic left/right and retroperitoneal), 498 subregions (common, external and internal iliac, obturator, presacral, aortic bifurcation, aortal, vena caval and interaortocaval) and 2,122 lymph nodes.
  
  
  RESULTS
  Lymph node metastasis was present in 32% of resected lymph nodes (681 of 2,122), resulting in 238 positive subregions and 111 positive regions. Positron emission tomography/computerized tomography was positive for 110 regions and 209 subregions. Sensitivity, specificity, positive and negative predictive values, and accuracy were 91.9%, 83.7%, 92.7%, 82.0% and 89.4% (region based), 80.7%, 93.5%, 91.9%, 84.1% and 87.3% (subregion based), and 57.0%, 98.4%, 94.5%, 82.6% and 84.9% (lesion based), respectively. Of 393 positive lymph node metastases detected by this method 278 (70.7%) were in lymph nodes with a less than 10 mm short axis diameter. Imaging sensitivity was 13.3%, 57.4% and 82.8% for a tumor infiltration depth of 2 or greater to less than 3 mm, 5 or greater to less than 6 mm and 10 or greater to less than 11 mm, respectively. Lymph node metastasis site and the radiotracer ((11)C-choline/(18)F-fluoroethylcholine) had no substantial impact on diagnostic accuracy.
  
  
  CONCLUSIONS
  Choline positron emission tomography/computerized tomography detects affected lymph node regions (pelvic left/right and retroperitoneal) in patients with prostate cancer relapse with high accuracy and it seems helpful for guiding salvage lymph node dissection. Sensitivity decreases with the size of metastatic infiltration in lymph nodes. This technique detects metastasis in a significant fraction of lymph nodes that are not pathologically enlarged on computerized tomography.
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York. Electronic address: cordula.jilg@uniklinik-freiburg.de.
authors: Cordula A
authors: CA
authors: Jilg
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
authors: Wolfgang
authors: W
authors: Schultze-Seemann
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
authors: Vanessa
authors: V
authors: Drendel
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
authors: Werner
authors: W
authors: Vach
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
authors: Gesche
authors: G
authors: Wieser
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
authors: Tobias
authors: T
authors: Krauss
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
authors: Anett
authors: A
authors: Jandausch
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
authors: Stefanie
authors: S
authors: Hölz
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
authors: Karl
authors: K
authors: Henne
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
authors: Sven N
authors: SN
authors: Reske
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
authors: Anca-L
authors: AL
authors: Grosu
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
authors: Wolfgang A
authors: WA
authors: Weber
authors: Departments of Urology (CAJ, WS-S, AJ, SH), Pathology (VD), Clinical Epidemiology (WV), Nuclear Medicine (GW, WAW, HCR), Radiology (TK) and Radiation Oncology (KH, HCR), Albert-Ludwigs University of Freiburg, Freiburg and Department of Nuclear Medicine, University of Ulm (SNR), Ulm, Germany, and Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center (WAW), New York, New York.
authors: H Christian
authors: HC
authors: Rischke
mesh_terms: D000368:Aged; D002250:Carbon Radioisotopes; D002794:Choline / Q000031:analogs & derivatives*; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D002250:Carbon Radioisotopes; C447081:methyl carbon-11 choline; C448902:fluoroethylcholine; D002794:Choline
keywords: computerized tomography; emission-computed; lymph node dissection; neoplasm metastasis; positron-emission tomography; prostate