[68Ga]PSMA-HBED uptake mimicking lymph node metastasis in coeliac ganglia: an important pitfall in clinical practice

Krohn, Thomas; Verburg, Frederik A.; Pufe, Thomas; Neuhuber, Winfried; Vogg, Andreas; Heinzel, Alexander; Mottaghy, Felix M.; Behrendt, Florian F.

doi:10.1007/s00259-014-2915-3

Cited by 161 publications

(164 citation statements)

References 10 publications

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“…However, the decision to use 68 Ga-PSMA imaging to rule out metastatic disease before prostatectomy must be made with caution and with an awareness of the patient's disease history and of the potential for false-positive findings. For example, recent studies and case reports have shown high 68 Ga-PSMA uptake in such conditions as schwannomas, celiac ganglia, and even differentiated thyroid cancer (22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Correlation of Intraprostatic Tumor Extent with ⁶⁸Ga-PSMA Distribution in Patients with Prostate Cancer

et al. 2016

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We evaluated the diagnostic value and accuracy of prostatespecific membrane antigen (PSMA) PET for the intraprostatic delineation of prostate cancer before prostatectomy. Methods: We identified 6 patients with biopsy-proven high-risk prostate cancer who were referred for 68 Ga-PSMA PET/CT before radical prostatectomy to rule out metastasis. After prostatectomy, a histologic map of the prostate was reconstructed. The histologic extent and Gleason score of each segment of the prostate were compared with 68 Ga-PSMA PET images resliced to the histologic axis. Sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios were calculated. The SUV of each segment was measured, and median values were compared. Results: Of the 132 segments, 112 were eligible for analysis. The correlation of histologic results with 68 Ga-PSMA PET images showed a specificity and sensitivity of 92%. The positive and negative likelihood ratio and the positive and negative predictive value for detection of prostate cancer on 68 Ga-PSMA PET were 11.5, 0.09, 96%, and 85%, respectively. The median SUV max of true-positive prostate segments was significantly higher than that of true-negative segments (11.0 ± 7.8 vs. 2.7 ± 0.9, P , 0.001), and a cutoff of 4 revealed a sensitivity and specificity of 86.5% and an accuracy of 87.5%. Conclusion: These preliminary results show that the intraprostatic localization and extent of prostate cancer may be estimated by 68 Ga-PSMA PET. This imaging method may be helpful for identifying target lesions before prostate biopsy and may support decision making before focal or radical therapy.

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Section: Discussionmentioning

confidence: 99%

Correlation of Intraprostatic Tumor Extent with ⁶⁸Ga-PSMA Distribution in Patients with Prostate Cancer

et al. 2016

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“…The most useful role of this tracer has been in cases of biochemical recurrence [8]. 68 Ga-PSMA-HBED-CC has been compared to 11 Cfluoromethylcholine in the diagnosis of PC and has been found to be more sensitive in the diagnosis of lymph node, central bone, and liver metastases [9]. Biodistribution studies have revealed uptake of the radiotracer in the lacrimal glands, salivary glands, liver, spleen, kidneys, small and large bowel besides lesions suspicious for PC [10].…”

Section: Discussionmentioning

confidence: 99%

“…Biodistribution studies have revealed uptake of the radiotracer in the lacrimal glands, salivary glands, liver, spleen, kidneys, small and large bowel besides lesions suspicious for PC [10]. Atypical uptake of this tracer has been reported in the celiac ganglion mimicking lymph nodes [11]. Thyroid incidentalomas are sometimes found in patients undergoing FDG PET/CT for unrelated causes and a significant proportion of them have been shown to harbor malignancy [12].…”

Section: Discussionmentioning

confidence: 99%

Unusual Uptake of Prostate Specific Tracer 68Ga-PSMA–HBED-CC in a Benign Thyroid Nodule

Damle

Tripathi

Chakraborty

et al. 2016

Nucl Med Mol Imaging

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68 Ga-Prostate specific membrane antigen-N,N′-bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine-N,N ′-diacetic acid-positron emission tomography/computed tomography or 68 Ga-HBED-CC-PSMA PET/CT, popularly known as PSMA PET/CT, is able to detect a small volume of recurrent prostate carcinoma (PC) when there is a prostate specific antigen (PSA) rise on follow-up after prostatectomy or other definitive treatment for PC. The use of PSMA PET/ CT in the initial staging in PC is uncertain at this time. Clinical studies are underway to define its exact role in the management of the disease. At the same time it is important to be aware of unexpected sites of uptake of this ligand. We present here the case of a 62-year-old male patient who underwent prostatectomy for adenocarcinoma prostate. He also had a long-standing left solitary thyroid nodule (STN). Four months after surgery, he had a rising trend in serum PSA levels on three occasions, but the absolute value was less than 4 at all times. He underwent a 68 Ga-PSMA-HBED-CC PET/CT, but it did not reveal any recurrent/metastatic site of disease. However, there was increased tracer uptake in the left STN.Fine needle aspiration cytology revealed features of atypia of undetermined significance, Bethesda category III. The patient underwent a left hemithyroidectomy and the histopathology showed features of a follicular adenoma.

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“…Thus, knowledge of the CT characteristics (e.g., size, shape, and specific location) is crucial for reliable differentiation. In a recent investigation, at least one celiac ganglion with increased PSMA ligand uptake mimicking retroperitoneal lymph node disease was found in 89% of patients undergoing 68 Ga-PSMA-11 PET/ CT examinations (96). Another important limitation is the absence of PSMA overexpression in the primary tumor or its metastases in up to 10% of patients with primary PC or (as mentioned above) decreased PSMA expression in advanced disease (21).…”

Section: Limitations and Pitfalls In Clinical Interpretationmentioning

confidence: 98%

PSMA Ligands for PET Imaging of Prostate Cancer

et al. 2017

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[68Ga]PSMA-HBED uptake mimicking lymph node metastasis in coeliac ganglia: an important pitfall in clinical practice

Abstract: Coeliac ganglia show a relevant [(68)Ga]PSMA-HBED uptake in most patients and may mimic lymph node metastases.

Cited by 161 publications

References 10 publications

Correlation of Intraprostatic Tumor Extent with ⁶⁸Ga-PSMA Distribution in Patients with Prostate Cancer

Correlation of Intraprostatic Tumor Extent with ⁶⁸Ga-PSMA Distribution in Patients with Prostate Cancer

Unusual Uptake of Prostate Specific Tracer 68Ga-PSMA–HBED-CC in a Benign Thyroid Nodule

PSMA Ligands for PET Imaging of Prostate Cancer

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[68Ga]PSMA-HBED uptake mimicking lymph node metastasis in coeliac ganglia: an important pitfall in clinical practice

Abstract: Coeliac ganglia show a relevant [(68)Ga]PSMA-HBED uptake in most patients and may mimic lymph node metastases.

Cited by 161 publications

References 10 publications

Correlation of Intraprostatic Tumor Extent with 68Ga-PSMA Distribution in Patients with Prostate Cancer

Correlation of Intraprostatic Tumor Extent with 68Ga-PSMA Distribution in Patients with Prostate Cancer

Unusual Uptake of Prostate Specific Tracer 68Ga-PSMA–HBED-CC in a Benign Thyroid Nodule

PSMA Ligands for PET Imaging of Prostate Cancer

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Correlation of Intraprostatic Tumor Extent with ⁶⁸Ga-PSMA Distribution in Patients with Prostate Cancer

Correlation of Intraprostatic Tumor Extent with ⁶⁸Ga-PSMA Distribution in Patients with Prostate Cancer