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Comprehensive evaluation of 68Ga-PSMA-11 PET/CT parameters for discriminating pathological characteristics in primary clear-cell renal cell carcinoma

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Abstract

Purpose

To evaluate parameters derived from 68Ga-PSMA-11 PET/CT images for discriminating pathological characteristics in primary clear-cell renal cell carcinoma (ccRCC).

Methods

The study retrospectively examined data for 36 ccRCC patients with preoperative 68Ga-PSMA-11 PET/CT scan and surgical specimens. Radiological parameters including maximal tumor diameter, mean CT value, and maximal standard uptake value (SUVmax) were derived from PET/CT images. Pathological characteristics included WHO/ISUP grade and adverse pathology (tumor necrosis or sarcomatoid or rhabdoid feature). Values of radiological parameters were compared within subgroups of pathological characteristics. Receiver operating characteristic (ROC) curve analysis was used for the effectiveness of radiological parameters in differentiating pathological characteristics, estimating area under the ROC curve (AUC) and 95% confidence intervals (CIs).

Results

The WHO/ISUP grade distribution for 36 tumors was grade 1, 9 (25.0%); grade 2, 12 (33.3%); grade 3, 9 (25.0%); and grade 4, 6 (16.7%). Adverse pathology was positive for 15 (41.7%). Radiological tumor diameter and SUVmax significantly differed by WHO/ISUP grade, pT stage, and adverse pathology (all P < 0.05), with no difference by CT value. Tumor diameter demonstrated sensitivity 86% and specificity 88% for pT stage, with cutoff 6.70 and AUC 0.91 (95% CI, 0.79–1.00, P < 0.001). SUVmax could effectively differentiate WHO/ISUP grade (3–4 vs. 1–2) and adverse pathology (positive vs. negative), with AUC 0.89 (95% CI, 0.81–0.98, P < 0.001), cutoff 16.4, sensitivity 100%, and specificity 71% and AUC 0.92 (95% CI, 0.85–0.99, P < 0.001), cutoff 18.5, sensitivity 94%, and specificity 87%, respectively.

Conclusion

68Ga-PSMA-11 PET/CT could effectively identify aggressive pathological features of ccRCC.

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Abbreviations

AUC:

area under the curve

ccRCC:

clear-cell renal cell carcinoma

CI:

confidence interval

IHC:

immunohistochemistry

PET/CT:

positron emission tomography/computed tomography

PSMA:

prostate-specific membrane antigen

RCC:

renal cell carcinoma

ROC:

receiver operating characteristic curve

ROIs:

regions of interest

SUVmax :

maximal standard uptake value

WHO/ISUP grade:

World Health Organization/International Society of Urological Pathology grade

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Funding

This research was supported by the National Natural Science Foundation of China (ID: 81772710, 81972388), the Project of Invigorating Health Care through Science, Technology and Education, Jiangsu Provincial Key Medical Discipline (Laboratory) (ZDXKB2016014) and  China Postdoctoral Science Foundation (2019T120418 and 2018M640477).

Author information

Author notes

  1. Jie Gao, Qinfeng Xu and Yao Fu contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Nanjing Drum Tower Hospital, Institute of Urology Nanjing University, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China

    Jie Gao, Kuiqiang He, Chengwei Zhang, Qing Zhang, Xiaozhi Zhao & Hongqian Guo

  2. Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China

    Qinfeng Xu & Feng Wang

  3. Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China

    Yao Fu & Jiong Shi

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  1. Jie Gao
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Correspondence to Xiaozhi Zhao, Feng Wang or Hongqian Guo.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Gao, J., Xu, Q., Fu, Y. et al. Comprehensive evaluation of 68Ga-PSMA-11 PET/CT parameters for discriminating pathological characteristics in primary clear-cell renal cell carcinoma. Eur J Nucl Med Mol Imaging 48, 561–569 (2021). https://doi.org/10.1007/s00259-020-04916-6

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