Reesink, D.J. (2015) Clinical relevance of incidental prostatic lesions on FDG-PET/CT scan : Should patients receive further evaluation? thesis, Medicine.
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Abstract
PURPOSE: To determine the clinical relevance of incidental prostatic uptake (IPU) of fluorine-18 fluoro-2-deoxy-D-glucose (FDG) on Positron Emission Tomography / Computed Tomography (PET/CT) for detecting prostate cancer (PCa). MATERIALS AND METHODS: All male bladder cancer patients who underwent a FDGPET/ CT scan and subsequently a radical cystoprostatectomy in the period from May 2009 to November 2014 were retrospectively analyzed. PET/CT scans were blindly revised by a dedicated nuclear physician, and the maximum Standardized Uptake Value (SUVmax) was determined. Subsequently, IPU was labeled as ‘suspect’, ‘inconclusive’ and ‘non-suspect’ for PCa. RESULTS: IPU was present in 43/108 patients (39.8%). Thirteen of these patients (30.2%) had occult PCa in the cystoprostatectomy specimen. Overall, occult PCa was found in 25/108 (23.2%) of the specimens. Sensitivity and specificity of the FDG-PET/CT for PCa were, respectively 52.0% and 63.9%. Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 30.3% and 81.5%, respectively. After labeling by the nuclear physician, 28/108 (25.9%) patients had IPU suspect for PCa, of which 8 were diagnosed with PCa (28.6%). Sensitivity, specificity, PPV and NPV changed to 32.0%, 75.6%, 28.6% and 78.8%, respectively. No correlation was found between SUVmax, Gleason-score and serum-PSA. CONCLUSIONS: IPU on FDG-PET/CT imaging has a low PPV in predicting PCa. An attempt to classify lesions as suspect or non-suspect for PCa did not increase diagnostic accuracy. Furthermore, almost 90% of the PCa found was low-risk. Based on these results, physicians should be cautious to apply invasive diagnostic methods to detect PCa in case of IPU on FDG-PET/CT.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair Begeleider: and Boerma, dr. M.O. |
| Supervisor name: | Supervisors: and Meijer, dr. R.P.M. and Horenblas, prof. dr. S. and Department of Urology and Nederlands Kanker Instituut - Antoni van and Leeuwenhoek, Amsterdam |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/170 |
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