Prostate incidentaloma on 18F-fluorodeoxyglucose positron emission tomography: Diagnostic value of volumetric positron emission tomography parameters

Abstract

Objective To evaluate whether volumetric PET parameters such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) contributed to maximum standardized uptake value (SUVmax) in predicting prostate carcinoma in the prostate incidentalomas (PI) in 18F-FDG PET/CT.

Materials and methods This retrospective study comprised 107 patients with PI of 4723 male patients who had undergone 18F-FDG PET/CT. SUVmax and volumetric PET parameters of PIs were assessed. MTV and TLG were acquired with each SUV threshold as 2.5, 3.0, 3.5, 4.0, 4.5, and 5.0.

Results The PI incidence was 2.3%, and the malignancy ratio of PI was 15.9%. According to further analysis results, 17 patients were in the malignant group, and 46 patients were in the benign group. Malignant PIs had higher SUVmax (10.6 vs. 6.4 and p<0.01), MTV (all p < 0.01) and TLG (all p < 0.01) than benign incidentalomas. All volumetric PET parameters had higher area under the curve (AUC) than SUVmax. SUVmax AUC was 0.835 [95% confidence interval (CI): 0.728–0.942]. MTV 2.5 and TLG 2.5 had the highest performance for predicting malignant PI.MTV2.5 AUC was 0.871 (95% CI: 0.775–0.968), and TLG2.5 AUC was 0.882 (95% CI: 0.797–0.967). Using TLG 2.5 greater than 29.8 as the cut-off point, the sensitivity and specificity for malignancy prediction were 94.1% and 82.6%, respectively.

Conclusion In this study, in which the effectiveness of volumetric parameters in the diagnosis of PI was evaluated for the first time, it was shown that they could potentially have clinical value along with SUVmax.

Zusammenfassung

Ziel Der Beitrag von PET-Volumenparametern in der 18F-FDG-PET/CT, wie dem metabolischen Tumorvolumen (MTV) und der „total lesion glycolysis“ (TLG), zusätzlich zum maximalen „standardized uptake value“ (SUV_max) zur Prädiktion von Prostatakarzinomen bei Prostata-Inzidentalomen (PI) sollte untersucht werden.

Material und Methoden Diese retrospektive Studie umfasste 107 Patienten mit PI aus 4723 männlichen Patienten, bei denen eine 18F-FDG-PET/CT durchgeführt wurde. SUV_max und PET-Volumenparameter der PIs wurden bewertet. MTV und TLG wurden bei jeder SUV-Schwelle (2,5; 3,0; 3,5; 4,0; 4,5 und 5,0) erfasst.

Ergebnisse Die Inzidenz des PI betrug 2,3% und dessen Malignität 15,9%. Nach den weiteren Analyseergebnissen waren 17 Patienten in der malignen Gruppe und 46 Patienten in der benignen Gruppe. Maligne PIs hatten höhere SUV_max (10,6 vs. 6,4; p<0,01), MTV (alle p<0,01) und TLG (alle p<0,01) als benigne Inzidentalome. Alle PET-Volumenparameter hatten eine höhere AUC als SUV_max. Die SUV_max-AUC betrug 0,835 (95%-Konfidenzintervall (KI) 0,728–0,942). MTV 2,5 und TLG 2,5 erbrachten die höchste Leistung zur Vorhersage eines malignen PI. Die MTV-2,5-AUC betrug 0,871 (95%-KI 0,775–0,968) und die TLG-2,5-AUC 0,882 (95%-KI: 0,797–0,967). Wenn ein TLG 2,5 größer 29,8 als Grenzwert verwendet wurde, dann lag die Sensitivität bei 94,1% und die Spezifität bei 82,6% in Bezug auf die Vorhersage der Malignität.

Schlussfolgerung In dieser Studie, in der die diagnostische Leistungsfähigkeit der Volumenparameter bei PI erstmalig evaluiert wurde, konnte gezeigt werden, dass diese zusammen mit SUV_max einen potenziellen klinischen Wert haben können.

Schlüsselwörter

Prostata-Inzidentalom - volumetrische PET-Parameter - MTV - TLG - SUV

Keywords

prostate incidentaloma - volumetric PET parameters - MTV - TLG - SUV

Publication History

Received: 13 February 2021

Accepted after revision: 07 June 2021

Article published online:
09 July 2021

• References

• 1 Bray F, Ferlay J, Soerjomataram I. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424 DOI: 10.3322/caac.21492. (PMID: 30207593)
• 2 Hoberück S, Michler E, Wunderlich G. et al. 68Ga-RM2 PET in PSMA- positive and -negative prostate cancer patients. Nuklearmedizin 2019; 58: 352-362 DOI: 10.1055/a-0990-8898. (PMID: 31443113)
• 3 Rayn KN, Elnabawi YA, Sheth N. Clinical implications of PET/CT in prostate cancer management. Transl Androl Urol 2018; 7: 844-854 DOI: 10.21037/tau.2018.08.26. (PMID: 30456187)
• 4 Mannas MP, Lee T, Pourghiasian M. et al. Incidentalomas of the prostate detected by 18- fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography. Can Urol Assoc J 2020; 14: E180-184 DOI: 10.5489/cuaj.5976. (PMID: 31793859)
• 5 Bertagna F, Sadeghi R, Giovanella L. et al. Incidental uptake of 18F-fluorodeoxyglucose in the prostate gland. Systematic review and meta-analysis on prevalence and risk of malignancy. Nuklearmedizin 2014; 53: 249-258 DOI: 10.3413/Nukmed-0668-14-05. (PMID: 25170975)
• 6 Bertagna F, Piccardo A, Dib B. et al. Multicentre study of 18F-FDG-PET/CT prostate incidental uptake. Jpn J Radiol 2015; 33: 538-546 DOI: 10.1007/s11604-015-0453-y. (PMID: 26153112)
• 7 Bhosale P, Balachandran A, Vikram R. et al. What is the clinical significance of FDG unexpected uptake in the prostate in patients undergoing PET/CT for other malignancies?. Int J Mol Imaging 2013; 2013: 476786 DOI: 10.1155/2013/476786. (PMID: 24455242)
• 8 Brown AM, Lindenberg ML, Sankineni S. et al. Does focal incidental 18F-FDG PET/CT uptake in the prostate have significance?. Abdom Imaging 2015; 40: 3222-3229 DOI: 10.1007/s00261-015-0520-y. (PMID: 26239399)
• 9 Cho SK, Choi JY, Yoo J. et al. Incidental focal (18)F-FDG uptake in the prostate: clinical significance and differential diagnostic criteria. Nucl Med Mol Imaging 2011; 45: 192-196 DOI: 10.1007/s13139-011-0092-x. (PMID: 24900003)
• 10 Hwang I, Chong A, Jung SI. et al. Is further evaluation needed for incidental focal uptake in the prostate in 18-fluoro-2-deoxyglucose positron emission tomography-computed tomography images?. Ann Nucl Med 2013; 27: 140-145 DOI: 10.1007/s12149-012-0663-7. (PMID: 23076866)
• 11 Kang PM, Seo WI, Lee SS. et al. Incidental abnormal FDG uptake in the prostate on 18- fluoro-2-deoxyglucose positron emission tomography-computed tomography scans. Asian Pac J Cancer Prev 2014; 15: 8699-8703 DOI: 10.7314/apjcp.2014.15.20.8699. (PMID: 25374193)
• 12 Kwon T, Jeong IG, You D. et al. Prevalence and clinical significance of incidental (18)F- fluoro-2-deoxyglucose uptake in prostate. Korean J Urol 2015; 56: 288-294 DOI: 10.4111/kju.2015.56.4.288. (PMID: 25874042)
• 13 Sahin E, Elboga U, Kalender E. et al. Clinical significance of incidental FDG uptake in the prostate gland detected by PET/CT. Int J Clin Exp Med 2015; 8: 10577-10585 (PMID: 26379847)
• 14 Yang Z, Hu S, Cheng J. et al. Prevalence and risk of cancer of incidental uptake in prostate identified by fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography. Clin Imaging 2014; 38: 470-474 DOI: 10.1016/j.clinimag.2014.01.019. (PMID: 24629790)
• 15 Treglia G, Bertagna F, Sadeghi R. et al. Focal thyroid incidental uptake detected by ¹⁸F- fluorodeoxyglucose positron emission tomography. Meta-analysis on prevalence and malignancy risk. Nuklearmedizin 2013; 52: 130-136 DOI: 10.3413/Nukmed-0568-13-03. (PMID: 23765102)
• 16 Kim BH, Kim SJ, Kim H. et al. Diagnostic value of metabolic tumor volume assessed by 18F-FDG PET/CT added to SUVmax for characterization of thyroid 18F-FDG incidentaloma. Nucl Med Commun 2013; 34: 868-876 DOI: 10.1097/MNM.0b013e328362d2d7. (PMID: 23797273)
• 17 Ceriani L, Milan L, Virili C. et al. Radiomics analysis of [18F]-fluorodeoxyglucose-avid thyroid incidentalomas improves risk stratification and selection for clinical assessment. Thyroid 2021; 31: 88-95 DOI: 10.1089/thy.2020.0224. (PMID: 32517585)
• 18 Shi H, Yuan Z, Yuan Z. et al. Diagnostic value of volume-based fluorine-18- fluorodeoxyglucose PET/CT parameters for characterizing thyroid incidentaloma. Korean J Radiol 2018; 19: 342-351 DOI: 10.3348/kjr.2018.19.2.342. (PMID: 29520193)
• 19 Seino H, Ono S, Miura H. et al. Incidental prostate ¹⁸F-FDG uptake without calcification indicates the possibility of prostate cancer. Oncol Rep 2014; 31: 1517-1522 DOI: 10.3892/or.2014.3011. (PMID: 24503866)
• 20 Chung JH, Yu J, Song W. et al. Strategy for prostate cancer patients with low prostate specific antigen level (2.5 to 4.0 ng/mL). J Korean Med Sci 2020; 35: e342 DOI: 10.3346/jkms.2020.35.e342. (PMID: 33107227)
• 21 Dong A, Bai Y, Wang Y. et al. Spectrum of the prostate lesions with increased FDG uptake on (18)F-FDG PET/CT. Abdom Imaging 2014; 39: 908-921
• 22 Ediz C, Cimen S, Akan S. et al. What should be the PSA threshold value? 2.5 or 4 ng/mL?. Int J Res Med Sci 2019; 7: 838-842
• 23 Jadvar H. Is there use for FDG-PET in prostate cancer?. Semin Nucl Med 2016; 46: 502-506 DOI: 10.1053/j.semnuclmed.2016.07.004. (PMID: 27825430)
• 24 Meziou S, Ringuette Goulet C, Hovington H. et al. GLUT1 expression in high-risk prostate cancer: correlation with 18F-FDG-PET/CT and clinical outcome. Prostate Cancer Prostatic Dis 2020; 23: 441-448 DOI: 10.1038/s41391-020-0202-x. (PMID: 31932660)
• 25 Reinicke K, Sotomayor P, Cisterna P. et al. Cellular distribution of Glut-1 and Glut-5 in benign and malignant human prostate tissue. J Cell Biochem 2012; 113: 553-562 DOI: 10.1002/jcb.23379. (PMID: 21938742)
• 26 Stewart GD, Gray K, Pennington CJ. et al. Analysis of hypoxia-associated gene expression in prostate cancer: lysyl oxidase and glucose transporter-1 expression correlate with Gleason score. Oncol Rep 2008; 20: 1561-1567 (PMID: 19020742)
• 27 Shiiba M, Ishihara K, Kimura G. et al. Evaluation of primary prostate cancer using 11C- methionine-PET/CT and 18F-FDG PET/CT. Ann Nucl Med 2012; 26: 138-145 DOI: 10.1007/s12149-011-0551-6. (PMID: 22069194)
• 28 Lee GH, Lee JH. Clinical significance of incidental prostatic fluorine-18- fluorodeoxyglucose uptake in the diagnosis of infectious prostatitis in adult males. Nucl Med Commun 2017; 38: 523-528 DOI: 10.1097/MNM.0000000000000668. (PMID: 28383319)
• 29 Reesink DJ, Fransen van de Putte EE, Vegt E. et al. Clinical relevance of incidental prostatic lesions on FDG-positron emission tomography/computerized tomography-should patients receive further evaluation?. J Urol 2016; 195: 907-912 DOI: 10.1016/j.juro.2015.11.025. (PMID: 26598424)
• 30 Millán-Rodríguez F, Palou J, Bujons-Tur A. et al. Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract. World J Urol 2006; 24: 45-50 DOI: 10.1007/s00345-005-0040-4. (PMID: 16437219)