[18F]-Fluciclovine PET/CT for preoperative nodal staging in high-risk primary prostate cancer: final results of a prospective trial

Purpose The conventional imaging flowchart for prostate cancer (PCa) staging may fail in correctly detecting lymph node metastases (LNM). Pelvic lymph node dissection (PLND) represents the only reliable method, although invasive. A new amino acid PET compound, [ 18 F]-fluciclovine, was recently auth...

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Published in:European journal of nuclear medicine and molecular imaging Vol. 49; no. 1; pp. 390 - 409
Main Authors: Zanoni, Lucia, Bianchi, Lorenzo, Nanni, Cristina, Pultrone, Cristian, Giunchi, Francesca, Bossert, Irene, Matti, Antonella, Schiavina, Riccardo, Fiorentino, Michelangelo, Romagnoli, Daniele, Fonti, Cristina, Lodi, Filippo, D’Errico, Antonietta, Brunocilla, Eugenio, Porreca, Angelo, Fanti, Stefano
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2021
Springer Nature B.V
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ISSN:1619-7070, 1619-7089
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Abstract Purpose The conventional imaging flowchart for prostate cancer (PCa) staging may fail in correctly detecting lymph node metastases (LNM). Pelvic lymph node dissection (PLND) represents the only reliable method, although invasive. A new amino acid PET compound, [ 18 F]-fluciclovine, was recently authorized in suspected PCa recurrence but not yet included in the standard staging work-up of primary PCa. A prospective monocentric study was designed to evaluate [ 18 F]-fluciclovine PET/CT diagnostic performance for preoperative LN staging in primary high-risk PCa. Methods Consecutive patients (pts) with biopsy-proven PCa, standard staging (including [ 11 C]choline PET/CT), eligible for PLND, were enrolled to undergo an investigational [ 18 F]-fluciclovine PET/CT. Nodal uptake higher than surrounding background was reported by at least two readers (blinded to [ 11 C]choline) using a visual 5-point scale (1–2 probably negative; 4–5 probably positive; 3 equivocal); SUVmax, target-to-background (aorta—A; bone marrow—BM) ratios (TBRs), were also calculated. PET results were validated with PLND. [ 18 F]-fluciclovine PET/CT performance using visual score and semi-quantitative indexes was analyzed both per patient and per LN anatomical region, compared to conventional [ 11 C]choline and clinical predictive factors (to note that diagnostic performance of [ 18 F]-fluciclovine was explored for LNM but not examined for intrapelvic or extrapelvic M1 lesions). Results Overall, 94 pts underwent [ 18 F]-fluciclovine PET/CT; 72/94 (77%) high-risk pts were included in the final analyses (22 pts excluded: 8 limited PLND; 3 intermediate-risk; 2 treated with radiotherapy; 4 found to be M1; 5 neoadjuvant hormonal therapy). Median LNM risk by Briganti nomogram was 19%. LNM confirmed on histology was 25% (18/72 pts). Overall, 1671 LN were retrieved; 45/1671 (3%) LNM detected. Per pt, median no. of removed LN was 22 (mean 23 ± 10; range 8–51), of LNM was 2 (mean 3 ± 2; range 1–10). Median LNM size was 5 mm (mean 5 ± 2.5; range 2–10). On patient-based analyses (n = 72), diagnostic performance for LNM resulted significant with [ 18 F]-fluciclovine (AUC 0.66, p 0.04; 50% sensitivity, 81% specificity, 47% PPV, 83% NPV, 74% accuracy), but not with [ 11 C]choline (AUC 0.60, p 0.2; 50%, 70%, 36%, 81%, and 65% respectively). Briganti nomogram (OR = 1.03, p  = 0.04) and [ 18 F]-fluciclovine visual score (≥ 4) (OR = 4.27, p  = 0.02) resulted independent predictors of LNM at multivariable analyses. On region-based semi-quantitative analyses (n = 576), PET/CT performed better using TBR parameters (TBR-A similar to TBR-BM; TBR-A fluciclovine AUC 0.61, p 0.35, vs choline AUC 0.57 p 0.54; TBR-BM fluciclovine AUC 0.61, p 0.36, vs choline AUC 0.58, p 0.52) rather than using absolute LN SUVmax (fluciclovine AUC 0.51, p 0.91, vs choline AUC 0.51, p 0.94). However, in all cases, diagnostic performance was not statistically significant for LNM detection, although slightly in favor of the experimental tracer [ 18 F]-fluciclovine for each parameter. On the contrary, visual interpretation significantly outperformed PET semi-quantitative parameters (choline and fluciclovine: AUC 0.65 and 0.64 respectively; p 0.03) and represents an independent predictive factor of LNM with both tracers, in particular [ 18 F]-fluciclovine (OR = 8.70, p 0.002, vs OR = 3.98, p  = 0.03). Conclusion In high-risk primary PCa, [ 18 F]-fluciclovine demonstrates some advantages compared with [ 11 C]choline but sensitivity for metastatic LN detection is still inadequate compared to PLND. Visual (combined morphological and functional), compared to semi-quantitative assessment, is promising but relies mainly on readers’ experience rather than on unquestionable LN avidity. Trial registration EudraCT number: 2014–003,165-15
AbstractList PurposeThe conventional imaging flowchart for prostate cancer (PCa) staging may fail in correctly detecting lymph node metastases (LNM). Pelvic lymph node dissection (PLND) represents the only reliable method, although invasive. A new amino acid PET compound, [18F]-fluciclovine, was recently authorized in suspected PCa recurrence but not yet included in the standard staging work-up of primary PCa. A prospective monocentric study was designed to evaluate [18F]-fluciclovine PET/CT diagnostic performance for preoperative LN staging in primary high-risk PCa.MethodsConsecutive patients (pts) with biopsy-proven PCa, standard staging (including [11C]choline PET/CT), eligible for PLND, were enrolled to undergo an investigational [18F]-fluciclovine PET/CT. Nodal uptake higher than surrounding background was reported by at least two readers (blinded to [11C]choline) using a visual 5-point scale (1–2 probably negative; 4–5 probably positive; 3 equivocal); SUVmax, target-to-background (aorta—A; bone marrow—BM) ratios (TBRs), were also calculated. PET results were validated with PLND. [18F]-fluciclovine PET/CT performance using visual score and semi-quantitative indexes was analyzed both per patient and per LN anatomical region, compared to conventional [11C]choline and clinical predictive factors (to note that diagnostic performance of [18F]-fluciclovine was explored for LNM but not examined for intrapelvic or extrapelvic M1 lesions).ResultsOverall, 94 pts underwent [18F]-fluciclovine PET/CT; 72/94 (77%) high-risk pts were included in the final analyses (22 pts excluded: 8 limited PLND; 3 intermediate-risk; 2 treated with radiotherapy; 4 found to be M1; 5 neoadjuvant hormonal therapy). Median LNM risk by Briganti nomogram was 19%. LNM confirmed on histology was 25% (18/72 pts). Overall, 1671 LN were retrieved; 45/1671 (3%) LNM detected. Per pt, median no. of removed LN was 22 (mean 23 ± 10; range 8–51), of LNM was 2 (mean 3 ± 2; range 1–10). Median LNM size was 5 mm (mean 5 ± 2.5; range 2–10). On patient-based analyses (n = 72), diagnostic performance for LNM resulted significant with [18F]-fluciclovine (AUC 0.66, p 0.04; 50% sensitivity, 81% specificity, 47% PPV, 83% NPV, 74% accuracy), but not with [11C]choline (AUC 0.60, p 0.2; 50%, 70%, 36%, 81%, and 65% respectively). Briganti nomogram (OR = 1.03, p = 0.04) and [18F]-fluciclovine visual score (≥ 4) (OR = 4.27, p = 0.02) resulted independent predictors of LNM at multivariable analyses. On region-based semi-quantitative analyses (n = 576), PET/CT performed better using TBR parameters (TBR-A similar to TBR-BM; TBR-A fluciclovine AUC 0.61, p 0.35, vs choline AUC 0.57 p 0.54; TBR-BM fluciclovine AUC 0.61, p 0.36, vs choline AUC 0.58, p 0.52) rather than using absolute LN SUVmax (fluciclovine AUC 0.51, p 0.91, vs choline AUC 0.51, p 0.94). However, in all cases, diagnostic performance was not statistically significant for LNM detection, although slightly in favor of the experimental tracer [18F]-fluciclovine for each parameter. On the contrary, visual interpretation significantly outperformed PET semi-quantitative parameters (choline and fluciclovine: AUC 0.65 and 0.64 respectively; p 0.03) and represents an independent predictive factor of LNM with both tracers, in particular [18F]-fluciclovine (OR = 8.70, p 0.002, vs OR = 3.98, p = 0.03).ConclusionIn high-risk primary PCa, [18F]-fluciclovine demonstrates some advantages compared with [11C]choline but sensitivity for metastatic LN detection is still inadequate compared to PLND. Visual (combined morphological and functional), compared to semi-quantitative assessment, is promising but relies mainly on readers’ experience rather than on unquestionable LN avidity.Trial registrationEudraCT number: 2014–003,165-15
The conventional imaging flowchart for prostate cancer (PCa) staging may fail in correctly detecting lymph node metastases (LNM). Pelvic lymph node dissection (PLND) represents the only reliable method, although invasive. A new amino acid PET compound, [ F]-fluciclovine, was recently authorized in suspected PCa recurrence but not yet included in the standard staging work-up of primary PCa. A prospective monocentric study was designed to evaluate [ F]-fluciclovine PET/CT diagnostic performance for preoperative LN staging in primary high-risk PCa. Consecutive patients (pts) with biopsy-proven PCa, standard staging (including [ C]choline PET/CT), eligible for PLND, were enrolled to undergo an investigational [ F]-fluciclovine PET/CT. Nodal uptake higher than surrounding background was reported by at least two readers (blinded to [ C]choline) using a visual 5-point scale (1-2 probably negative; 4-5 probably positive; 3 equivocal); SUVmax, target-to-background (aorta-A; bone marrow-BM) ratios (TBRs), were also calculated. PET results were validated with PLND. [ F]-fluciclovine PET/CT performance using visual score and semi-quantitative indexes was analyzed both per patient and per LN anatomical region, compared to conventional [ C]choline and clinical predictive factors (to note that diagnostic performance of [ F]-fluciclovine was explored for LNM but not examined for intrapelvic or extrapelvic M1 lesions). Overall, 94 pts underwent [ F]-fluciclovine PET/CT; 72/94 (77%) high-risk pts were included in the final analyses (22 pts excluded: 8 limited PLND; 3 intermediate-risk; 2 treated with radiotherapy; 4 found to be M1; 5 neoadjuvant hormonal therapy). Median LNM risk by Briganti nomogram was 19%. LNM confirmed on histology was 25% (18/72 pts). Overall, 1671 LN were retrieved; 45/1671 (3%) LNM detected. Per pt, median no. of removed LN was 22 (mean 23 ± 10; range 8-51), of LNM was 2 (mean 3 ± 2; range 1-10). Median LNM size was 5 mm (mean 5 ± 2.5; range 2-10). On patient-based analyses (n = 72), diagnostic performance for LNM resulted significant with [ F]-fluciclovine (AUC 0.66, p 0.04; 50% sensitivity, 81% specificity, 47% PPV, 83% NPV, 74% accuracy), but not with [ C]choline (AUC 0.60, p 0.2; 50%, 70%, 36%, 81%, and 65% respectively). Briganti nomogram (OR = 1.03, p = 0.04) and [ F]-fluciclovine visual score (≥ 4) (OR = 4.27, p = 0.02) resulted independent predictors of LNM at multivariable analyses. On region-based semi-quantitative analyses (n = 576), PET/CT performed better using TBR parameters (TBR-A similar to TBR-BM; TBR-A fluciclovine AUC 0.61, p 0.35, vs choline AUC 0.57 p 0.54; TBR-BM fluciclovine AUC 0.61, p 0.36, vs choline AUC 0.58, p 0.52) rather than using absolute LN SUVmax (fluciclovine AUC 0.51, p 0.91, vs choline AUC 0.51, p 0.94). However, in all cases, diagnostic performance was not statistically significant for LNM detection, although slightly in favor of the experimental tracer [ F]-fluciclovine for each parameter. On the contrary, visual interpretation significantly outperformed PET semi-quantitative parameters (choline and fluciclovine: AUC 0.65 and 0.64 respectively; p 0.03) and represents an independent predictive factor of LNM with both tracers, in particular [ F]-fluciclovine (OR = 8.70, p 0.002, vs OR = 3.98, p = 0.03). In high-risk primary PCa, [ F]-fluciclovine demonstrates some advantages compared with [ C]choline but sensitivity for metastatic LN detection is still inadequate compared to PLND. Visual (combined morphological and functional), compared to semi-quantitative assessment, is promising but relies mainly on readers' experience rather than on unquestionable LN avidity. EudraCT number: 2014-003,165-15.
Purpose The conventional imaging flowchart for prostate cancer (PCa) staging may fail in correctly detecting lymph node metastases (LNM). Pelvic lymph node dissection (PLND) represents the only reliable method, although invasive. A new amino acid PET compound, [ 18 F]-fluciclovine, was recently authorized in suspected PCa recurrence but not yet included in the standard staging work-up of primary PCa. A prospective monocentric study was designed to evaluate [ 18 F]-fluciclovine PET/CT diagnostic performance for preoperative LN staging in primary high-risk PCa. Methods Consecutive patients (pts) with biopsy-proven PCa, standard staging (including [ 11 C]choline PET/CT), eligible for PLND, were enrolled to undergo an investigational [ 18 F]-fluciclovine PET/CT. Nodal uptake higher than surrounding background was reported by at least two readers (blinded to [ 11 C]choline) using a visual 5-point scale (1–2 probably negative; 4–5 probably positive; 3 equivocal); SUVmax, target-to-background (aorta—A; bone marrow—BM) ratios (TBRs), were also calculated. PET results were validated with PLND. [ 18 F]-fluciclovine PET/CT performance using visual score and semi-quantitative indexes was analyzed both per patient and per LN anatomical region, compared to conventional [ 11 C]choline and clinical predictive factors (to note that diagnostic performance of [ 18 F]-fluciclovine was explored for LNM but not examined for intrapelvic or extrapelvic M1 lesions). Results Overall, 94 pts underwent [ 18 F]-fluciclovine PET/CT; 72/94 (77%) high-risk pts were included in the final analyses (22 pts excluded: 8 limited PLND; 3 intermediate-risk; 2 treated with radiotherapy; 4 found to be M1; 5 neoadjuvant hormonal therapy). Median LNM risk by Briganti nomogram was 19%. LNM confirmed on histology was 25% (18/72 pts). Overall, 1671 LN were retrieved; 45/1671 (3%) LNM detected. Per pt, median no. of removed LN was 22 (mean 23 ± 10; range 8–51), of LNM was 2 (mean 3 ± 2; range 1–10). Median LNM size was 5 mm (mean 5 ± 2.5; range 2–10). On patient-based analyses (n = 72), diagnostic performance for LNM resulted significant with [ 18 F]-fluciclovine (AUC 0.66, p 0.04; 50% sensitivity, 81% specificity, 47% PPV, 83% NPV, 74% accuracy), but not with [ 11 C]choline (AUC 0.60, p 0.2; 50%, 70%, 36%, 81%, and 65% respectively). Briganti nomogram (OR = 1.03, p  = 0.04) and [ 18 F]-fluciclovine visual score (≥ 4) (OR = 4.27, p  = 0.02) resulted independent predictors of LNM at multivariable analyses. On region-based semi-quantitative analyses (n = 576), PET/CT performed better using TBR parameters (TBR-A similar to TBR-BM; TBR-A fluciclovine AUC 0.61, p 0.35, vs choline AUC 0.57 p 0.54; TBR-BM fluciclovine AUC 0.61, p 0.36, vs choline AUC 0.58, p 0.52) rather than using absolute LN SUVmax (fluciclovine AUC 0.51, p 0.91, vs choline AUC 0.51, p 0.94). However, in all cases, diagnostic performance was not statistically significant for LNM detection, although slightly in favor of the experimental tracer [ 18 F]-fluciclovine for each parameter. On the contrary, visual interpretation significantly outperformed PET semi-quantitative parameters (choline and fluciclovine: AUC 0.65 and 0.64 respectively; p 0.03) and represents an independent predictive factor of LNM with both tracers, in particular [ 18 F]-fluciclovine (OR = 8.70, p 0.002, vs OR = 3.98, p  = 0.03). Conclusion In high-risk primary PCa, [ 18 F]-fluciclovine demonstrates some advantages compared with [ 11 C]choline but sensitivity for metastatic LN detection is still inadequate compared to PLND. Visual (combined morphological and functional), compared to semi-quantitative assessment, is promising but relies mainly on readers’ experience rather than on unquestionable LN avidity. Trial registration EudraCT number: 2014–003,165-15
Author Porreca, Angelo
Bianchi, Lorenzo
Giunchi, Francesca
Nanni, Cristina
Zanoni, Lucia
Brunocilla, Eugenio
Bossert, Irene
Matti, Antonella
Fonti, Cristina
D’Errico, Antonietta
Fanti, Stefano
Pultrone, Cristian
Lodi, Filippo
Schiavina, Riccardo
Romagnoli, Daniele
Fiorentino, Michelangelo
Author_xml – sequence: 1
  givenname: Lucia
  orcidid: 0000-0002-6784-8220
  surname: Zanoni
  fullname: Zanoni, Lucia
  email: lucia.zanoni@aosp.bo.it
  organization: Nuclear Medicine, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna
– sequence: 2
  givenname: Lorenzo
  surname: Bianchi
  fullname: Bianchi, Lorenzo
  organization: Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna
– sequence: 3
  givenname: Cristina
  surname: Nanni
  fullname: Nanni, Cristina
  organization: Nuclear Medicine, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna
– sequence: 4
  givenname: Cristian
  surname: Pultrone
  fullname: Pultrone, Cristian
  organization: Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna
– sequence: 5
  givenname: Francesca
  surname: Giunchi
  fullname: Giunchi, Francesca
  organization: Pathology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna
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  givenname: Irene
  surname: Bossert
  fullname: Bossert, Irene
  organization: Nuclear Medicine, Istituti Clinici Scientifici Maugeri
– sequence: 7
  givenname: Antonella
  surname: Matti
  fullname: Matti, Antonella
  organization: Nuclear Medicine, IRCCS Ospedale Sacro Cuore - Don Calabria
– sequence: 8
  givenname: Riccardo
  surname: Schiavina
  fullname: Schiavina, Riccardo
  organization: Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna
– sequence: 9
  givenname: Michelangelo
  surname: Fiorentino
  fullname: Fiorentino, Michelangelo
  organization: Department of Specialistic Diagnostic and Experimental Medicine, University of Bologna
– sequence: 10
  givenname: Daniele
  surname: Romagnoli
  fullname: Romagnoli, Daniele
  organization: Urology Unit, Abano Terme Hospital
– sequence: 11
  givenname: Cristina
  surname: Fonti
  fullname: Fonti, Cristina
  organization: Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Istituto Delle Scienze Neurologiche Di Bologna
– sequence: 12
  givenname: Filippo
  surname: Lodi
  fullname: Lodi, Filippo
  organization: Nuclear Medicine, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna
– sequence: 13
  givenname: Antonietta
  surname: D’Errico
  fullname: D’Errico, Antonietta
  organization: Pathology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna
– sequence: 14
  givenname: Eugenio
  surname: Brunocilla
  fullname: Brunocilla, Eugenio
  organization: Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna
– sequence: 15
  givenname: Angelo
  surname: Porreca
  fullname: Porreca, Angelo
  organization: Oncological Urology, Veneto Institute of Oncology IOV - IRCCS
– sequence: 16
  givenname: Stefano
  surname: Fanti
  fullname: Fanti, Stefano
  organization: Nuclear Medicine, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, DIMES, University of Bologna
BackLink https://www.ncbi.nlm.nih.gov/pubmed/34213609$$D View this record in MEDLINE/PubMed
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Copyright The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021
2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021.
Copyright_xml – notice: The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021
– notice: 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
– notice: The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021.
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Issue 1
Keywords High risk
F]-Fluciclovine PET/CT
Lymph node staging
[
Prostate cancer
[18F]-Fluciclovine PET/CT
Language English
License 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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PublicationTitle European journal of nuclear medicine and molecular imaging
PublicationTitleAbbrev Eur J Nucl Med Mol Imaging
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PublicationYear 2021
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Springer Nature B.V
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Fendler WP, Eiber M, Beheshti M, Bomanji J, Ceci F, Cho S, et al. 68Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. Eur J Nucl Med Mol Imaging. Springer Berlin; 2017;44:1014–24
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GabrieleDColluraDOderdaMSturaIFioritoCPorpigliaFIs there still a role for computed tomography and bone scintigraphy in prostate cancer staging? An analysis from the EUREKA-1 databaseWorld J Urol Springer Verlag20163451752310.1007/s00345-015-1669-21:CAS:528:DC%2BC2MXhtlOmsrbJ
HövelsAMHeesakkersRAMAdangEMJagerGJStrumSHoogeveenYLThe diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysisClin Radiol Clin Radiol20086338739510.1016/j.crad.2007.05.022
Nanni C, Zanoni L, Bach-Gansmo T, Minn H, Willoch F, Bogsrud TV, et al. [18F]Fluciclovine PET/CT: joint EANM and SNMMI procedure guideline for prostate cancer imaging—version 1.0. Eur J Nucl Med Mol Imaging. 2020;47.
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SelnæsKMKrüger-StokkeBElschotMWillochFStørkersenØSandsmarkE18F-Fluciclovine PET/MRI for preoperative lymph node staging in high-risk prostate cancer patientsEur Radiol Springer Verlag2018283151315910.1007/s00330-017-5213-1
Hoekstra RJ, Beulens A, Vrijhof EHJEJ, Wyndaele DNJ, Roef M, Brouwer LJM, et al. Diagnostic accuracy of 18F-fluciclovine PET/CT in primary lymph node staging of prostate cancer. Nucl Med Commun. 2021;42(5):476–481.
KanagawaMDoiYOkaSKobayashiRNakataNToyamaMComparison of trans-1-amino-3-[18F]fluorocyclobutanecarboxylic acid (anti-[18F]FACBC) accumulation in lymph node prostate cancer metastasis and lymphadenitis in ratsNucl Med Biol. Elsevier Inc.2014415455110.1016/j.nucmedbio.2014.04.0041:CAS:528:DC%2BC2cXns1GitL8%3D
UprimnyCKroissASDecristoforoCFritzJvon GuggenbergEKendlerD68Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumourEur J Nucl Med Mol Imaging. Springer Berlin201744941910.1007/s00259-017-3631-61:CAS:528:DC%2BC2sXhvVSisbg%3D
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Farolfi A Ceci F Castellucci P Graziani T Siepe G Lambertini A et al 68Ga-PSMA-11 PET/CT in prostate cancer patients with biochemical recurrence after radical prostatectomy and PSA <0.5 ng/ml Efficacy and impact on treatment strategy Eur J Nucl Med Mol Imaging Springer Berlin Heidelberg 2019 4611 9
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References_xml – reference: Farolfi A Ceci F Castellucci P Graziani T Siepe G Lambertini A et al 68Ga-PSMA-11 PET/CT in prostate cancer patients with biochemical recurrence after radical prostatectomy and PSA <0.5 ng/ml Efficacy and impact on treatment strategy Eur J Nucl Med Mol Imaging Springer Berlin Heidelberg 2019 4611 9
– reference: Giesel FL, Sterzing F, Schlemmer HP, Holland-Letz T, Mier & W, Rius & M, et al. Intra-individual comparison of 68 Ga-PSMA-11-PET/CT and multi-parametric MR for imaging of primary prostate cancer. Eur J Nucl Med Mol Imaging. 2016;43(8):1400–6. 
– reference: SchiavinaRScattoniVCastellucciPPicchioMCortiBBrigantiA11C-Choline positron emission tomography/computerized tomography for preoperative lymph-node staging in intermediate-risk and high-risk prostate cancer: comparison with clinical staging nomogramsEur Urol Eur Urol20085439240110.1016/j.eururo.2008.04.030
– reference: TiguertRGheilerELTefilliMVOskanianPBanerjeeMGrignonDJLymph node size does not correlate with the presence of prostate cancer metastasisUrology Urology19995336737110.1016/S0090-4295(98)00518-41:STN:280:DyaK1M7ivFygtA%3D%3D
– reference: Fendler WP, Eiber M, Beheshti M, Bomanji J, Ceci F, Cho S, et al. 68Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. Eur J Nucl Med Mol Imaging. Springer Berlin; 2017;44:1014–24
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Snippet Purpose The conventional imaging flowchart for prostate cancer (PCa) staging may fail in correctly detecting lymph node metastases (LNM). Pelvic lymph node...
The conventional imaging flowchart for prostate cancer (PCa) staging may fail in correctly detecting lymph node metastases (LNM). Pelvic lymph node dissection...
PurposeThe conventional imaging flowchart for prostate cancer (PCa) staging may fail in correctly detecting lymph node metastases (LNM). Pelvic lymph node...
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SubjectTerms Amino acids
Aorta
Avidity
Biopsy
Bone marrow
Cardiology
Choline
Computed tomography
Diagnostic systems
Flow charts
Fluorine isotopes
Histology
Humans
Imaging
Invasiveness
Lymph nodes
Lymphatic Metastasis
Lymphatic system
Male
Mathematical analysis
Medicine
Medicine & Public Health
Metastases
Neoplasm Staging
Nomograms
Nuclear Medicine
Oncology
Oncology – Genitourinary
Original Article
Orthopedics
Parameters
Patients
Performance indices
Positron Emission Tomography Computed Tomography
Prospective Studies
Prostate cancer
Prostatic Neoplasms - diagnostic imaging
Prostatic Neoplasms - pathology
Radiation therapy
Radiology
Risk
Sensitivity
Statistical analysis
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Title [18F]-Fluciclovine PET/CT for preoperative nodal staging in high-risk primary prostate cancer: final results of a prospective trial
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