PRIMARY scoring in 68Ga-PSMA PET/CT: correlation with prostate cancer risk groups and its potential impact on active surveillance.

IF 2.5 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Annals of Nuclear Medicine Pub Date : 2024-11-23 DOI:10.1007/s12149-024-02004-5

Hatice Uslu, Dilruba Şahin, Ebru İbişoğlu, Mehmet Tarık Tatoğlu

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Abstract

Objective: The PRIMARY scoring system is a scale designed to identify clinically significant intraprostatic malignancies on 68Ga-PSMA PET/CT images. Active surveillance is a management method for patients with low-risk prostate cancer. In this study, we aimed to assess the efficacy of PRIMARY scoring in identifying appropriate candidates for active surveillance based on the distribution within prostate cancer risk groups.

Methods: The data of 134 patients diagnosed with PCa by biopsy who underwent 68Ga-PSMA PET/CT imaging for post-diagnostic staging purposes were retrospectively analyzed. Age, total PSA, ISUP grade, prostate lesion SUVmax values, PI-RADS scores, and PRIMARY scores were recorded. Patients were classified into low-risk and intermediate/high-risk groups.

Results: In the intermediate/high-risk group, the PRIMARY score was 1-2 in 17.6% and 3-5 in 82.4% of patients. In the low-risk group, the PRIMARY score was 1-2 in 34.7% and 3-5 in 65.3% of patients. None of the patients in the low-risk group had a PRIMARY score of 5. The most frequent PRIMARY score in both groups was 4, and there was a significant difference between the average SUVmax values of the intermediate/high and low-risk groups with a PRIMARY score of 4 (p = 0.018). The sensitivity of PRIMARY scoring in detecting patients in the intermediate/high-risk group was 82.3%, the specificity was 34.6%, and the positive predictive value (PPV) was 68.6%. When a cut-off SUVmax value 5.0 was used for the PRIMARY score of 4, the sensitivity was 67.0%, the specificity was 65.3% and the PPV was 77.0%. In the ROC analysis, the area under the curve was 0.727 for PRIMARY scoring, 0.662 for PI-RADS, and 0.744 for their combined mean.

Conclusion: The PRIMARY scoring system can complement PI-RADS scoring in mpMRI for selecting patients suitable for active surveillance. Revising the PRIMARY score 4 with an SUVmax cut-off value may increase the specificity.

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68Ga-PSMA PET/CT 的 PRIMARY 评分：与前列腺癌高危人群的相关性及其对主动监测的潜在影响。

目的：PRIMARY 评分系统是一种用于识别 68Ga-PSMA PET/CT 图像上具有临床意义的前列腺内恶性肿瘤的量表。主动监测是低风险前列腺癌患者的一种治疗方法。在这项研究中，我们旨在评估 PRIMARY 评分在根据前列腺癌风险组内的分布情况确定适当的主动监测候选者方面的功效：方法：我们回顾性分析了 134 名经活检确诊为 PCa 的患者的数据，这些患者接受了 68Ga-PSMA PET/CT 成像检查以进行诊断后分期。记录了患者的年龄、总 PSA、ISUP 分级、前列腺病变 SUVmax 值、PI-RADS 评分和 PRIMARY 评分。患者被分为低风险组和中/高风险组：结果：在中/高风险组中，PRIMARY评分为1-2分的患者占17.6%，3-5分的患者占82.4%。在低风险组中，34.7%的患者 PRIMARY 评分为 1-2 分，65.3%的患者 PRIMARY 评分为 3-5 分。在低风险组中，没有一名患者的 PRIMARY 评分达到 5 分。两组中最常见的 PRIMARY 评分均为 4 分，PRIMARY 评分为 4 分的中/高危组和低危组的平均 SUVmax 值有显著差异（p = 0.018）。PRIMARY 评分检测中/高危组患者的灵敏度为 82.3%，特异度为 34.6%，阳性预测值（PPV）为 68.6%。当 PRIMARY 评分 4 的 SUVmax 临界值为 5.0 时，灵敏度为 67.0%，特异性为 65.3%，PPV 为 77.0%。在 ROC 分析中，PRIMARY 评分的曲线下面积为 0.727，PI-RADS 为 0.662，两者的综合平均值为 0.744：结论：PRIMARY 评分系统可以补充 PI-RADS 在 mpMRI 中的评分，用于选择适合积极监测的患者。用 SUVmax 临界值修订 PRIMARY 评分 4 可能会提高特异性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Nuclear Medicine 医学-核医学

CiteScore

4.90

自引率

7.70%

发文量

111

审稿时长

4-8 weeks

期刊介绍： Annals of Nuclear Medicine is an official journal of the Japanese Society of Nuclear Medicine. It develops the appropriate application of radioactive substances and stable nuclides in the field of medicine. The journal promotes the exchange of ideas and information and research in nuclear medicine and includes the medical application of radionuclides and related subjects. It presents original articles, short communications, reviews and letters to the editor.