Comparison of 68 Ga-PSMA ligand PET/CT versus conventional cross-sectional imaging for target volume delineation for metastasis-directed radiotherapy for metachronous lymph node metastases from prostate cancer

Introduction: Prostate cancer (PCa) staging is an integral part in the management of prostate cancer. The gold standard for diagnosing lymph node invasion is a surgical lymphadenectomy, with no superior imaging modality available at the clinician’s disposal. Our aim in this study is to identify if a pre-biopsy multiparametric MRI (mpMRI) can provide enough information about pelvic lymph nodes in intermediate and high risk PCa patients, and whether it can substitute further cross sectional imaging (CSI) modalities of the abdomen and pelvis in these risk categories. Methods: Patients with intermediate and high risk prostate cancer were collected between January 2015 and June 2019, while excluding patients who did not undergo a pre-biopsy mpMRI or a CSI. Date regarding biopsy result, PSA, MRI results, CSI imaging results were collected. Using Statistical Package for the Social Sciences (SPSS) version 24.0, statistical analysis was conducted using the Cohen’s Kappa agreement for comparison of mpMRI with CSI. McNemar’s test and receiver operator curve (ROC) curve were used for comparison of sensitivity of both tests when comparing to the gold standard of lymphadenectomy. Results: A total of 143 patients fit the inclusion criteria. We further stratified our patients into according to PSA level and Gleason score. Overall, agreement between mpMRI and all CSI was 0.857. When stratifying patients based on Gleason score and PSA, the higher the grade or PSA, the higher agreement between mpMRI and CSI. The sensitivity of mpMRI (73.7%) is similar to CSI (68.4%). When comparing CSI sensitivity to that of mpMRI, no significant difference was present by utilizing the McNemar test and very similar receiver operating characteristic curve. Conclusion: A pre-biopsy mpMRI can potentially substitute further cross sectional imaging in our cohort of patients. However, larger prospective studies are needed to confirm our findings.

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Exploration of the Radiotherapeutic Clinical Target Volume Delineation for Gastric Cancer from Lymph Node Metastases

Anticancer Research ◽

10.21873/anticanres.11864 ◽

2017 ◽

Vol 37 (8) ◽

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Clinical Target Volume ◽

Target Volume ◽

Target Volume Delineation ◽

Volume Delineation ◽

Node Metastases

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Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume delineation of regional lymph node in patients with gastric carcinoma

Radiotherapy and Oncology ◽

10.1016/j.radonc.2010.04.031 ◽

2010 ◽

Vol 96 (2) ◽

pp. 223-230 ◽

Cited By ~ 11

Author(s):

Yan Yi ◽

Jinming Yu ◽

Baosheng Li ◽

Fujun Yang ◽

Wei Huang ◽

...

Keyword(s):

Lymph Node ◽

Gastric Carcinoma ◽

Lymph Node Metastases ◽

Clinical Target Volume ◽

Regional Lymph Node ◽

Target Volume ◽

Target Volume Delineation ◽

Volume Delineation ◽

Node Metastases

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Su1468 – Can Regional Lymph Node Metastases from Pancreatic Cancer Be Predicted with Cross-Sectional Imaging?

Gastroenterology ◽

10.1016/s0016-5085(19)40669-0 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-1446

Author(s):

katelyn flick ◽

Ted A. Seltman ◽

Nicholas J. Zyromski ◽

Eugene P. Ceppa ◽

Christian Schmidt ◽

...

Keyword(s):

Pancreatic Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Regional Lymph Node ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Node Metastases ◽

Sectional Imaging

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Comparison of cross-sectional imaging techniques for the detection of prostate cancer lymph node metastasis: a critical review

Translational Andrology and Urology ◽

10.21037/tau.2020.03.20 ◽

2020 ◽

Vol 9 (3) ◽

pp. 1415-1427

Author(s):

Amir H. Lebastchi ◽

Nikhil Gupta ◽

John M. DiBianco ◽

Morand Piert ◽

Matthew S. Davenport ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Critical Review ◽

Imaging Techniques ◽

Cross Sectional ◽

Node Metastasis ◽

Cross Sectional Imaging ◽

Sectional Imaging

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The value of lymph node ultrasound and whole body PET/CT in stage IIB/C patients prior to SLNB.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e22079 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e22079-e22079

Author(s):

Emma H.A. Stahlie ◽

Bernies Van Der Hiel ◽

Annemarie Bruining ◽

Michel W.J.M. Wouters ◽

Yvonne Schrage ◽

...

Keyword(s):

Lymph Node ◽

High Risk ◽

Whole Body ◽

Preoperative Imaging ◽

Cross Sectional ◽

Primary Tumors ◽

Pet Ct ◽

Cross Sectional Imaging ◽

Melanoma Patients ◽

Sectional Imaging

e22079 Background: Stage IIB/IIC (pT3b-T4N0) patients are known to have high-risk primary tumors, even higher risk than some stage IIIA/B melanomas (AJCC Staging System 8th edition), however they follow the same routine to sentinel lymph node biopsy (SLNB) as more low-risk tumors. A priori the risk of finding SLNB or other metastases is much higher for these thick and/or ulcerated primary melanomas compared to the thinner ones. Guidelines are not conclusive regarding the use of preoperative imaging in these cases. Recently, a trend to more frequently use cross-sectional imaging has been noticed. However, others have previously shown that preoperative ultrasound was the most sensitive. The aim of this pilot study was to assess the value of ultrasound (US) and Positron Emission Tomography/Computerized Tomography (PET/CT) prior to SLNB for stage IIB/C (pT3b-T4N0) melanoma patients. Methods: Starting 2019-04, all patients with a pT3b melanoma or higher (8th AJCC) were included. All patients underwent US and PET/CT before their planned lymphoscintigraphy and routine SLNB. Suspected metastases were confirmed with cytologic puncture. Results: A total of 20 patients were screened. Seven patients (35%) had metastases detected by imaging: one by PET/CT, three by US and three by both imaging modalities. Three of these metastases were detected by US as well as PET/CT. All metastases were nodal. For all seven patients treatment was altered to lymph node dissection with adjuvant therapy. Of the 13 patients in whom no metastases were identified by imaging, six (46%) still had a positive sentinel node (SN). Conclusions: This study showed that this select group of patients had a high risk of metastases prior to SLNB and that all recurrences except one, were detected by ultrasound. This suggests that nodal staging with US is sufficient and can replace the need for SLNB when metastases is proven with cytology. Despite negative imaging, SLNB cannot be foregone for pT3b-pT4N0 melanoma patients, as many still have an involved SN. Cross-sectional imaging can be reserved for patients after positive cytology or SN to confirm the absence of distant visceral metastases.

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