Detection and localization of prostate cancer: correlation of (11)C-choline PET/CT with histopathologic step-section analysis

• Published in: The Journal of nuclear medicine (1978) Vol. 46; no. 10; p. 1642
• Main Authors: Farsad, Mohsen, Schiavina, Riccardo, Castellucci, Paolo, Nanni, Cristina, Corti, Barbara, Martorana, Giuseppe, Canini, Romeo, Grigioni, Walter, Boschi, Stefano, Marengo, Mario, Pettinato, Cinzia, Salizzoni, Eugenio, Monetti, Nino, Franchi, Roberto, Fanti, Stefano
• Format: Journal Article
• Language: English
• Published: United States 01.10.2005
• Subjects: Aged; Choline; Humans; Image Enhancement - methods; Male; Middle Aged; Neoplasm Staging; Positron-Emission Tomography - methods; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - pathology; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Statistics as Topic; Tomography, X-Ray Computed - methods
• ISSN: 0161-5505

This study evaluated the potential usefulness of (11)C-choline PET/CT for detection and localization of tumors within the prostate. We used the results of step-section histopathologic examination as the standard of reference. The results were analyzed on a sextant basis. We reviewed the results of the (11)C-choline PET/CT scans of 36 patients with prostate cancer and of 5 control subjects with bladder cancer. All patients underwent (11)C-choline PET/CT and, subsequently, radical prostatectomy with lymph node dissection within 1 mo. (11)C-Choline PET/CT scans were obtained 5-10 min after intravenous injection of 370-555 MBq of (11)C-choline. Images were reviewed visually and semiquantitatively using maximum SUV and tumor-to-background ratio. On a sextant basis, histopathologic analysis detected cancer foci in 143 of 216 sextants; high-grade prostate intraepithelial neoplasm foci were detected in 89 of 216 sextants (in 59 sextants in association with carcinoma, in 30 sextants alone), acute prostatitis was detected in 7 of 216 sextants (in 3 sextants in association with carcinoma, in 4 sextants alone), and 39 of 216 sextants were normal. PET/CT demonstrated focal (11)C-choline uptake in 108 sextants (94 of which involved tumor), and 108 sextants showed no abnormal (11)C-choline uptake (49 of which were false negative). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT were 66%, 81%, 71%, 87%, and 55%, respectively. In the 5 control subjects, high-grade prostate intraepithelial neoplasm was detected at histologic examination in 16 of 30 sextants. PET/CT showed increased (11)C-choline uptake in 5 of 16 sextants. This study demonstrated the feasibility of using (11)C-choline PET/CT to identify cancer foci within the prostate. However, we also found that (11)C-choline PET/CT has a relative high rate of false-negative results on a sextant basis and that prostatic disorders other than cancer may accumulate (11)C-choline. Therefore, our data do not support the routine use of PET/CT with (11)C-choline as a first-line screening procedure for prostate cancer in men at high risk.