title: Final analysis of a prospective trial on functional imaging for nodal staging in patients with prostate cancer at high risk for lymph node involvement.
abstract: OBJECTIVE
  Accurate staging modalities to diagnose lymph node involvement in patients with prostate cancer (PCa) are lacking. We wanted to prospectively assess sensitivity, specificity, and positive predictive value (PPV) and negative predictive value of (11)C-choline positron emission tomography (PET)-computed tomography (CT) and diffusion-weighted (DW) magnetic resonance imaging (MRI) for nodal staging in patients with PCa at high risk for lymph node involvement.
  
  
  METHODS
  In total, 75 patients with a risk≥10% but<35% for lymph node (LN) metastases (Partin tables) who had N0 lesions based on the findings of contrast-enhanced CT scans were included. Patients underwent (11)C-choline PET-CT and DW MRI before surgery, which consisted of a superextended lymph node dissection followed by radical prostatectomy. LNs were serially sectioned and histopathologically examined after pankeratin staining. These results were used as the gold standard to compare with the imaging results.
  
  
  RESULTS
  Of 1,665 resected LNs (median = 21, range: 7-49), 106 affected LNs (median = 2, range: 1-10) were found in 37 of 75 patients (49%). On a region-based analysis, we found a low sensitivity of 8.2% and 9.5% and a PPV of 50.0% and 40.0% for (11)C-choline PET-CT and DW MRI, respectively. The patient-based analysis showed a sensitivity of 18.9% and 36.1% for and a PPV of 63.6% and 86.7% (11)C-choline PET-CT and DW MRI, respectively. Even when both imaging modalities were combined, sensitivity values remained too low to be clinically useful.
  
  
  CONCLUSIONS
  Because of the low sensitivity, there is no indication for routine clinical use of either (11)C-choline PET-CT or DW MRI for LN staging in patients with PCa, in whom CT scan findings were normal.
authors: Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium. Electronic address: laura.vandenbergh@uzleuven.be.
authors: Laura
authors: L
authors: Van den Bergh
authors: Pathology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
authors: Evelyne
authors: E
authors: Lerut
authors: Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium.
authors: Karin
authors: K
authors: Haustermans
authors: Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium.
authors: Christophe M
authors: CM
authors: Deroose
authors: Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Radiology, University Hospitals Leuven, Belgium.
authors: Raymond
authors: R
authors: Oyen
authors: Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium.
authors: Sofie
authors: S
authors: Isebaert
authors: Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium; Department of Radiotherapy, Catharinaziekenhuis Eindhoven, Eindhoven, the Netherlands.
authors: Tom
authors: T
authors: Budiharto
authors: Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
authors: Filip
authors: F
authors: Ameye
authors: Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany.
authors: Felix M
authors: FM
authors: Mottaghy
authors: l-Biostat, KU Leuven, Leuven, Belgium.
authors: Kris
authors: K
authors: Bogaerts
authors: Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
authors: Hendrik
authors: H
authors: Van Poppel
authors: Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
authors: Steven
authors: S
authors: Joniau
mesh_terms: D000368:Aged; D001706:Biopsy; D002250:Carbon Radioisotopes; D002794:Choline / Q000737:chemistry; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging / Q000379:methods*; D049451:Nomograms; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D002250:Carbon Radioisotopes; D002794:Choline
keywords: Diffusion-weighted magnetic resonance imaging; Lymph nodes; Positron emission tomography; Prostatic neoplasms; Staging