TY - JOUR
T1 - Equivocal bone lesions on PSMA PET/CT
T2 - systematic review and meta-analysis on their prevalence and malignancy rate
AU - Woo, Sungmin
AU - Freedman, Daniel
AU - Becker, Anton S.
AU - Leithner, Doris
AU - Mayerhoefer, Marius E.
AU - Friedman, Kent P.
AU - Arita, Yuki
AU - Han, Sangwon
AU - Burger, Irene A.
AU - Taneja, Samir S.
AU - Wise, David R.
AU - Zelefsky, Michael J.
AU - Vargas, Hebert A.
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Italian Association of Nuclear Medicine and Molecular Imaging 2024.
PY - 2024/10
Y1 - 2024/10
N2 - Purpose: Prostate-specific membrane antigen (PSMA) PET/CT has an established reliable diagnostic performance for detecting metastases in prostate cancer. However, there are increasing instances of scans demonstrating equivocal bone lesions, with non-specific uptake and without a definite benign or malignant CT correlate. To date, the prevalence, malignancy rate, and relationship with radioligand type ([18F] PSMA-1007 vs. others ([68Ga]Ga-PSMA-11 and [18F] DCFPyL) for these equivocal lesions have not been extensively established. Methods: A systematic review and meta-analysis was conducted on equivocal bone lesions. Pubmed and EMBASE were searched up to December 11, 2023. Quality of the studies was evaluated using QUADAS-2. The following proportions were pooled using random-effects model: (1) prevalence of equivocal bone lesions (i.e., number of patients with one or more equivocal bone lesions/number of patients with PSMA PET/CT) and (2) their malignancy rates (i.e., number of metastases/number of equivocal bone lesions). Subgroup analyses based on radioligand type, clinical setting, and definition of equivocal bone lesion were performed. Results: Twenty-five studies (4484 patients) were included. Pooled prevalence of equivocal bone lesions was 20% (95%CI, 12–31%). [18F]PSMA-1007 was associated with a greater prevalence of equivocal lesions compared with other radioligands: 36% (95%CI 26–48%) vs. 8% (95%CI, 4–14%), respectively, p < 0.01. Pooled malignancy rate of equivocal bone lesions was 14% (95%CI, 7–25%). [18F]PSMA-1007 was associated with a lower malignancy rate compared to other radioligands: 8% (95%CI, 3–19%) vs. 29% (95%CI, 17–44%), respectively, p = 0.01. There were no signficant difference in prevalence or malignancy rate between subgroups stratified to clinical setting or definition of equivocal bone lesions (p = 0.32–0.60). Conclusions: Equivocal bone lesions are often encountered on PSMA PET/CT but exihibit a low malignancy rate. Compared to other radioligands, [18F]PSMA-1007 requires special attention as it is associated with a higher frequency and lower rate of metastasis.
AB - Purpose: Prostate-specific membrane antigen (PSMA) PET/CT has an established reliable diagnostic performance for detecting metastases in prostate cancer. However, there are increasing instances of scans demonstrating equivocal bone lesions, with non-specific uptake and without a definite benign or malignant CT correlate. To date, the prevalence, malignancy rate, and relationship with radioligand type ([18F] PSMA-1007 vs. others ([68Ga]Ga-PSMA-11 and [18F] DCFPyL) for these equivocal lesions have not been extensively established. Methods: A systematic review and meta-analysis was conducted on equivocal bone lesions. Pubmed and EMBASE were searched up to December 11, 2023. Quality of the studies was evaluated using QUADAS-2. The following proportions were pooled using random-effects model: (1) prevalence of equivocal bone lesions (i.e., number of patients with one or more equivocal bone lesions/number of patients with PSMA PET/CT) and (2) their malignancy rates (i.e., number of metastases/number of equivocal bone lesions). Subgroup analyses based on radioligand type, clinical setting, and definition of equivocal bone lesion were performed. Results: Twenty-five studies (4484 patients) were included. Pooled prevalence of equivocal bone lesions was 20% (95%CI, 12–31%). [18F]PSMA-1007 was associated with a greater prevalence of equivocal lesions compared with other radioligands: 36% (95%CI 26–48%) vs. 8% (95%CI, 4–14%), respectively, p < 0.01. Pooled malignancy rate of equivocal bone lesions was 14% (95%CI, 7–25%). [18F]PSMA-1007 was associated with a lower malignancy rate compared to other radioligands: 8% (95%CI, 3–19%) vs. 29% (95%CI, 17–44%), respectively, p = 0.01. There were no signficant difference in prevalence or malignancy rate between subgroups stratified to clinical setting or definition of equivocal bone lesions (p = 0.32–0.60). Conclusions: Equivocal bone lesions are often encountered on PSMA PET/CT but exihibit a low malignancy rate. Compared to other radioligands, [18F]PSMA-1007 requires special attention as it is associated with a higher frequency and lower rate of metastasis.
KW - Equivocal bone lesion
KW - Positron emission tomography
KW - Prostate cancer
KW - Prostate specific membrane antigen
KW - Unspecific bone uptake
KW - [F]PSMA-1007
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U2 - 10.1007/s40336-024-00631-6
DO - 10.1007/s40336-024-00631-6
M3 - Review article
AN - SCOPUS:85188835975
SN - 2281-5872
VL - 12
SP - 485
EP - 500
JO - Clinical and Translational Imaging
JF - Clinical and Translational Imaging
IS - 5
ER -