Skip to main content

Advertisement

Log in

Prospective comparison of computed tomography, diffusion-weighted magnetic resonance imaging and [11C]choline positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer patients

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to prospectively compare diffusion-weighted magnetic resonance imaging (DWI) and [11C]choline positron emission tomography/computed tomography (PET/CT) with computed tomography (CT) for preoperative lymph node (LN) staging in prostate cancer (PCa) patients.

Methods

Between June 2010 and May 2012, CT, DWI and [11C]choline PET/CT were performed preoperatively in 33 intermediate- and high-risk PCa patients undergoing radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) including obturator fossa and internal, external and common iliac fields. Patient- and field-based performance characteristics for all three imaging techniques based on histopathological results are reported. Imaging techniques were compared by means of the area under the curve (AUC).

Results

LN metastases were detected in 92 of 1,012 (9 %) LNs from 14 of 33 (42 %) patients. On patient-based analysis, sensitivity, specificity and accuracy for CT were 57, 68 and 64 %, respectively, for DWI were 57, 79 and 70 %, respectively, and for [11C]choline PET/CT were 57, 90 and 76 %, respectively. On field-based analysis, these numbers for CT were 47, 94 and 88 %, respectively, for DWI were 56, 97 and 92 %, respectively, and for [11C]choline PET/CT were 62, 96 and 92 %, respectively. Neither DWI nor [11C]choline PET/CT performed significantly better than CT on pairwise comparison of patient- and field-based results.

Conclusion

All three imaging techniques exhibit a rather low sensitivity with less than two thirds of LN metastases being detected on patient- and field-based analysis. Overall diagnostic efficacy did not differ significantly between imaging techniques, whereas distinct performance characteristics, esp. patient-based specificity, were best for [11C]choline PET/CT followed by DWI and CT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cheng L, Zincke H, Blute ML, Bergstralh EJ, Scherer B, Bostwick DG. Risk of prostate carcinoma death in patients with lymph node metastasis. Cancer 2001;91:66–73.

    Article  CAS  PubMed  Google Scholar 

  2. Briganti A, Karnes JR, Da Pozzo LF, Cozzarini C, Gallina A, Suardi N, et al. Two positive nodes represent a significant cut-off value for cancer specific survival in patients with node positive prostate cancer. A new proposal based on a two-institution experience on 703 consecutive N+ patients treated with radical prostatectomy, extended pelvic lymph node dissection and adjuvant therapy. Eur Urol 2009;55:261–70.

    Article  PubMed  Google Scholar 

  3. Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 2012;61:480–7.

    Article  PubMed  Google Scholar 

  4. Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 2011;59:61–71.

    Article  PubMed  Google Scholar 

  5. Hövels AM, Heesakkers RAM, Adang EM, Jager GJ, Strum S, Hoogeveen YL, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 2008;63:387–95.

    Article  PubMed  Google Scholar 

  6. NCCN clinical practice guidelines in oncology 2012: prostate cancer. http://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf.

  7. Bader P, Burkhard FC, Markwalder R, Studer UE. Is a limited lymph node dissection an adequate staging procedure for prostate cancer? J Urol 2002;168:514–8. discussion 518.

    Article  PubMed  Google Scholar 

  8. Heidenreich A, Varga Z, Von Knobloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 2002;167:1681–6.

    Article  PubMed  Google Scholar 

  9. Weckermann D, Dorn R, Trefz M, Wagner T, Wawroschek F, Harzmann R. Sentinel lymph node dissection for prostate cancer: experience with more than 1,000 patients. J Urol 2007;177:916–20.

    Article  PubMed  Google Scholar 

  10. Heck MM, Retz M, Bandur M, Souchay M, Vitzthum E, Weirich G, et al. Topography of lymph node metastases in prostate cancer patients undergoing radical prostatectomy and extended lymphadenectomy: results of a combined molecular and histopathologic mapping study. Eur Urol 2013. doi:10.1016/j.eururo.2013.02.007.

    PubMed  Google Scholar 

  11. Briganti A, Abdollah F, Nini A, Suardi N, Gallina A, Capitanio U, et al. Performance characteristics of computed tomography in detecting lymph node metastases in contemporary patients with prostate cancer treated with extended pelvic lymph node dissection. Eur Urol 2012;61:1132–8.

    Article  PubMed  Google Scholar 

  12. Heesakkers RAM, Hövels AM, Jager GJ, van den Bosch HCM, Witjes JA, Raat HPJ, et al. MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study. Lancet Oncol 2008;9:850–6.

    Article  CAS  PubMed  Google Scholar 

  13. Contractor K, Challapalli A, Barwick T, Winkler M, Hellawell G, Hazell S, et al. Use of [11C]choline PET-CT as a noninvasive method for detecting pelvic lymph node status from prostate cancer and relationship with choline kinase expression. Clin Cancer Res 2011;17:7673–83.

    Article  CAS  PubMed  Google Scholar 

  14. Eiber M, Beer AJ, Holzapfel K, Tauber R, Ganter C, Weirich G, et al. Preliminary results for characterization of pelvic lymph nodes in patients with prostate cancer by diffusion-weighted MR-imaging. Invest Radiol 2010;45:15–23.

    Article  PubMed  Google Scholar 

  15. Eiber M, Holzapfel K, Ganter C, Epple K, Metz S, Geinitz H, et al. Whole-body MRI including diffusion-weighted imaging (DWI) for patients with recurring prostate cancer: technical feasibility and assessment of lesion conspicuity in DWI. J Magn Reson Imaging 2011;33:1160–70.

    Article  PubMed  Google Scholar 

  16. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998;280:969–74.

    Article  PubMed  Google Scholar 

  17. Pascali C, Bogni A, Iwata R, Cambiè M, Bombardieri E. [11C]Methylation on a C18 Sep-Pak cartridge: a convenient way to produce [N-methyl-11C]choline. J Labelled Comp Radiopharm 2000;43:195–203.

    Article  CAS  Google Scholar 

  18. Jakoby BW, Bercier Y, Watson CC, Rappoport V, Young J, Bendriem B, et al. Physical performance and clinical workflow of a new LSO HI-REZ PET/CT scanner. IEEE Nucl Sci Symp Conf Rec 2006;5:3130–4.

    Google Scholar 

  19. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44:837–45.

    Google Scholar 

  20. Obuchowski NA. Nonparametric analysis of clustered ROC curve data. Biometrics 1997;53:567–78.

    Article  CAS  PubMed  Google Scholar 

  21. Team RDC: R: a language and environment for statistical computing. http://www.r-project.org

  22. Schiavina R, Scattoni V, Castellucci P, Picchio M, Corti B, Briganti A, et al. 11C-choline positron emission tomography/computerized tomography for preoperative lymph-node staging in intermediate-risk and high-risk prostate cancer: comparison with clinical staging nomograms. Eur Urol 2008;54:392–401.

    Article  PubMed  Google Scholar 

  23. Budiharto T, Joniau S, Lerut E, Van den Bergh L, Mottaghy F, Deroose CM, et al. 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. Eur Urol 2011;60:125–30.

    Article  PubMed  Google Scholar 

  24. Evangelista L, Guttilla A, Zattoni F, Muzzio PC, Zattoni F. Utility of choline positron emission tomography/computed tomography for lymph node involvement identification in intermediate- to high-risk prostate cancer: a systematic literature review and meta-analysis. Eur Urol 2013;63:1040–8. doi:10.1016/j.eururo.2012.09.039.

    Article  PubMed  Google Scholar 

  25. de Jong IJ, Pruim J, Elsinga PH, Vaalburg W, Mensink HJ. Preoperative staging of pelvic lymph nodes in prostate cancer by 11C-choline PET. J Nucl Med 2003;44:331–5.

    PubMed  Google Scholar 

  26. de Jong IJ, Pruim J, Elsinga PH, Vaalburg W, Mensink HJA. Visualization of prostate cancer with 11C-choline positron emission tomography. Eur Urol 2002;42:18–23.

    Article  PubMed  Google Scholar 

  27. Poulsen MH, Bouchelouche K, Høilund-Carlsen PF, Petersen H, Gerke O, Steffansen SI, et al. [(18)F]fluoromethylcholine (FCH) positron emission tomography/computed tomography (PET/CT) for lymph node staging of prostate cancer: a prospective study of 210 patients. BJU Int 2012;110:1666–71.

    Article  CAS  PubMed  Google Scholar 

  28. Maurer T, Souvatzoglou M, Kübler H, Opercan K, Schmidt S, Herrmann K, et al. Diagnostic efficacy of [11C]choline positron emission tomography/computed tomography compared with conventional computed tomography in lymph node staging of patients with bladder cancer prior to radical cystectomy. Eur Urol 2012;61:1031–8.

    Article  PubMed  Google Scholar 

  29. Weingärtner K, Ramaswamy A, Bittinger A, Gerharz EW, Vöge D, Riedmiller H. Anatomical basis for pelvic lymphadenectomy in prostate cancer: results of an autopsy study and implications for the clinic. J Urol 1996;156:1969–71.

    Article  PubMed  Google Scholar 

  30. Vandecaveye V, De Keyzer F, Vander Poorten V, Dirix P, Verbeken E, Nuyts S, et al. Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology 2009;251:134–46.

    Article  PubMed  Google Scholar 

  31. Beer AJ, Eiber M, Souvatzoglou M, Holzapfel K, Ganter C, Weirich G, et al. Restricted water diffusibility as measured by diffusion-weighted MR imaging and choline uptake in (11)C-choline PET/CT are correlated in pelvic lymph nodes in patients with prostate cancer. Mol Imaging Biol 2011;13:352–61.

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matthias M. Heck.

Additional information

Bernd Krause and Matthias Eiber shared senior authorship.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heck, M.M., Souvatzoglou, M., Retz, M. et al. Prospective comparison of computed tomography, diffusion-weighted magnetic resonance imaging and [11C]choline positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer patients. Eur J Nucl Med Mol Imaging 41, 694–701 (2014). https://doi.org/10.1007/s00259-013-2634-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-013-2634-1

Keywords

Navigation