18F-fluciclovine parameters on targeted prostate biopsy associated with true positivity in recurrent prostate cancer

Olayinka A. Abiodun-Ojo, Akinyemi A. Akintayo, Oladunni O. Akin-Akintayo, Funmilayo I. Tade, Peter T. Nieh, Viraj A. Master, Mehrdad Alemozaffar, Adeboye O. Osunkoya, Mark M. Goodman, Baowei Fei, David M. Schuster

Research output: Contribution to journalArticle

Abstract

We evaluated 18F-fluciclovine uptake parameters that correlate with true positivity for local recurrence in non–prostatectomy-treated patients. Methods: Twenty-one patients (prostate-specific antigen level, 7.4 ± 6.8 ng/mL) with biochemical recurrence after nonprostatectomy local therapy (radiotherapy and cryotherapy) underwent dual–time-point 18F-fluciclovine (364.1 ± 37.7 MBq) PET/CT from pelvis to diaphragm. Prostatic uptake over background was delineated and coregistered to a prostate-biopsy–planning ultrasound. Transrectal biopsies of 18F-fluciclovine–defined targets were completed using a 3-dimensional visualization and navigation platform. Histologic analyses of lesions were completed. Lesion characteristics including SUVmax, target-to-background ratio (TBR), uptake pattern, and subjective reader’s suspicion level were compared between true-positive (malignant) and false-positive (benign) lesions. Univariate analysis was used to determine the association between PET and histologic findings. Receiver-operating-characteristic curves were plotted to determine discriminatory cutoffs for TBR. Statistical significance was set at a P value of less than 0.05. Results: Fifty lesions were identified in 21 patients on PET. Seventeen of 50 (34.0%) targeted lesions in 10 of 21 patients were positive for malignancy. True-positive lesions had a significantly higher SUVmax (6.62 ± 1.70 vs. 4.92 ± 1.27), marrow TBR (2.57 ± 0.81 vs. 1.69 ± 0.51), and blood-pool TBR (4.10 ± 1.17 vs. 2.99 ± 1.01) than false-positive lesions at the early time point (P, 0.01) and remained significant at the delayed time point, except for blood-pool TBR. Focal uptake (odds ratio, 12.07; 95% confidence interval, 2.98–48.80; P, 0.01) and subjective highest suspicion level (odds ratio, 10.91; 95% confidence interval, 1.19–99.69; P 5 0.03) correlated with true positivity. Using the receiver-operating-characteristic curve, optimal cutoffs for marrow TBR were 1.9 (area under the curve, 0.82) and 1.8 (area under the curve, 0.85) at early and delayed imaging, respectively. With these cutoffs, 15 of 17 malignant lesions were identified at both time points; however, fewer false-positive lesions were detected at the delayed time point (5/ 33) than at the early time point (11/33). Conclusion: True positivity of 18F-fluciclovine–targeted prostate biopsy in non–prostatectomytreated patients correlates with focal uptake, TBR (blood pool and marrow), and subjective highest suspicion level. A marrow TBR of 1.9 at the early time point and 1.8 at the delayed time point had optimal discriminating capabilities. Despite the relatively low intraprostate positive predictive value (34.0%) with 18F-fluciclovine, application of these parameters to interpretative criteria may improve true positivity in the treated prostate.

Original languageEnglish (US)
Pages (from-to)1531-1536
Number of pages6
JournalJournal of Nuclear Medicine
Volume60
Issue number11
DOIs
StatePublished - Jan 1 2019

Fingerprint

Prostate
Prostatic Neoplasms
Biopsy
Recurrence
Bone Marrow
ROC Curve
Area Under Curve
Odds Ratio
Confidence Intervals
Cryotherapy
Molecular Imaging
Prostate-Specific Antigen
Diaphragm
Pelvis
Radiotherapy
Neoplasms

Keywords

  • F-fluciclovine
  • Prostate
  • Recurrence
  • Targeted biopsy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Abiodun-Ojo, O. A., Akintayo, A. A., Akin-Akintayo, O. O., Tade, F. I., Nieh, P. T., Master, V. A., ... Schuster, D. M. (2019). 18F-fluciclovine parameters on targeted prostate biopsy associated with true positivity in recurrent prostate cancer. Journal of Nuclear Medicine, 60(11), 1531-1536. https://doi.org/10.2967/jnumed.119.227033

18F-fluciclovine parameters on targeted prostate biopsy associated with true positivity in recurrent prostate cancer. / Abiodun-Ojo, Olayinka A.; Akintayo, Akinyemi A.; Akin-Akintayo, Oladunni O.; Tade, Funmilayo I.; Nieh, Peter T.; Master, Viraj A.; Alemozaffar, Mehrdad; Osunkoya, Adeboye O.; Goodman, Mark M.; Fei, Baowei; Schuster, David M.

In: Journal of Nuclear Medicine, Vol. 60, No. 11, 01.01.2019, p. 1531-1536.

Research output: Contribution to journalArticle

Abiodun-Ojo, OA, Akintayo, AA, Akin-Akintayo, OO, Tade, FI, Nieh, PT, Master, VA, Alemozaffar, M, Osunkoya, AO, Goodman, MM, Fei, B & Schuster, DM 2019, '18F-fluciclovine parameters on targeted prostate biopsy associated with true positivity in recurrent prostate cancer', Journal of Nuclear Medicine, vol. 60, no. 11, pp. 1531-1536. https://doi.org/10.2967/jnumed.119.227033
Abiodun-Ojo, Olayinka A. ; Akintayo, Akinyemi A. ; Akin-Akintayo, Oladunni O. ; Tade, Funmilayo I. ; Nieh, Peter T. ; Master, Viraj A. ; Alemozaffar, Mehrdad ; Osunkoya, Adeboye O. ; Goodman, Mark M. ; Fei, Baowei ; Schuster, David M. / 18F-fluciclovine parameters on targeted prostate biopsy associated with true positivity in recurrent prostate cancer. In: Journal of Nuclear Medicine. 2019 ; Vol. 60, No. 11. pp. 1531-1536.
@article{f823ffb0cacb46cbb7b1dfb39219dbe4,
title = "18F-fluciclovine parameters on targeted prostate biopsy associated with true positivity in recurrent prostate cancer",
abstract = "We evaluated 18F-fluciclovine uptake parameters that correlate with true positivity for local recurrence in non–prostatectomy-treated patients. Methods: Twenty-one patients (prostate-specific antigen level, 7.4 ± 6.8 ng/mL) with biochemical recurrence after nonprostatectomy local therapy (radiotherapy and cryotherapy) underwent dual–time-point 18F-fluciclovine (364.1 ± 37.7 MBq) PET/CT from pelvis to diaphragm. Prostatic uptake over background was delineated and coregistered to a prostate-biopsy–planning ultrasound. Transrectal biopsies of 18F-fluciclovine–defined targets were completed using a 3-dimensional visualization and navigation platform. Histologic analyses of lesions were completed. Lesion characteristics including SUVmax, target-to-background ratio (TBR), uptake pattern, and subjective reader’s suspicion level were compared between true-positive (malignant) and false-positive (benign) lesions. Univariate analysis was used to determine the association between PET and histologic findings. Receiver-operating-characteristic curves were plotted to determine discriminatory cutoffs for TBR. Statistical significance was set at a P value of less than 0.05. Results: Fifty lesions were identified in 21 patients on PET. Seventeen of 50 (34.0{\%}) targeted lesions in 10 of 21 patients were positive for malignancy. True-positive lesions had a significantly higher SUVmax (6.62 ± 1.70 vs. 4.92 ± 1.27), marrow TBR (2.57 ± 0.81 vs. 1.69 ± 0.51), and blood-pool TBR (4.10 ± 1.17 vs. 2.99 ± 1.01) than false-positive lesions at the early time point (P, 0.01) and remained significant at the delayed time point, except for blood-pool TBR. Focal uptake (odds ratio, 12.07; 95{\%} confidence interval, 2.98–48.80; P, 0.01) and subjective highest suspicion level (odds ratio, 10.91; 95{\%} confidence interval, 1.19–99.69; P 5 0.03) correlated with true positivity. Using the receiver-operating-characteristic curve, optimal cutoffs for marrow TBR were 1.9 (area under the curve, 0.82) and 1.8 (area under the curve, 0.85) at early and delayed imaging, respectively. With these cutoffs, 15 of 17 malignant lesions were identified at both time points; however, fewer false-positive lesions were detected at the delayed time point (5/ 33) than at the early time point (11/33). Conclusion: True positivity of 18F-fluciclovine–targeted prostate biopsy in non–prostatectomytreated patients correlates with focal uptake, TBR (blood pool and marrow), and subjective highest suspicion level. A marrow TBR of 1.9 at the early time point and 1.8 at the delayed time point had optimal discriminating capabilities. Despite the relatively low intraprostate positive predictive value (34.0{\%}) with 18F-fluciclovine, application of these parameters to interpretative criteria may improve true positivity in the treated prostate.",
keywords = "F-fluciclovine, Prostate, Recurrence, Targeted biopsy",
author = "Abiodun-Ojo, {Olayinka A.} and Akintayo, {Akinyemi A.} and Akin-Akintayo, {Oladunni O.} and Tade, {Funmilayo I.} and Nieh, {Peter T.} and Master, {Viraj A.} and Mehrdad Alemozaffar and Osunkoya, {Adeboye O.} and Goodman, {Mark M.} and Baowei Fei and Schuster, {David M.}",
year = "2019",
month = "1",
day = "1",
doi = "10.2967/jnumed.119.227033",
language = "English (US)",
volume = "60",
pages = "1531--1536",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine Inc.",
number = "11",

}

TY - JOUR

T1 - 18F-fluciclovine parameters on targeted prostate biopsy associated with true positivity in recurrent prostate cancer

AU - Abiodun-Ojo, Olayinka A.

AU - Akintayo, Akinyemi A.

AU - Akin-Akintayo, Oladunni O.

AU - Tade, Funmilayo I.

AU - Nieh, Peter T.

AU - Master, Viraj A.

AU - Alemozaffar, Mehrdad

AU - Osunkoya, Adeboye O.

AU - Goodman, Mark M.

AU - Fei, Baowei

AU - Schuster, David M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - We evaluated 18F-fluciclovine uptake parameters that correlate with true positivity for local recurrence in non–prostatectomy-treated patients. Methods: Twenty-one patients (prostate-specific antigen level, 7.4 ± 6.8 ng/mL) with biochemical recurrence after nonprostatectomy local therapy (radiotherapy and cryotherapy) underwent dual–time-point 18F-fluciclovine (364.1 ± 37.7 MBq) PET/CT from pelvis to diaphragm. Prostatic uptake over background was delineated and coregistered to a prostate-biopsy–planning ultrasound. Transrectal biopsies of 18F-fluciclovine–defined targets were completed using a 3-dimensional visualization and navigation platform. Histologic analyses of lesions were completed. Lesion characteristics including SUVmax, target-to-background ratio (TBR), uptake pattern, and subjective reader’s suspicion level were compared between true-positive (malignant) and false-positive (benign) lesions. Univariate analysis was used to determine the association between PET and histologic findings. Receiver-operating-characteristic curves were plotted to determine discriminatory cutoffs for TBR. Statistical significance was set at a P value of less than 0.05. Results: Fifty lesions were identified in 21 patients on PET. Seventeen of 50 (34.0%) targeted lesions in 10 of 21 patients were positive for malignancy. True-positive lesions had a significantly higher SUVmax (6.62 ± 1.70 vs. 4.92 ± 1.27), marrow TBR (2.57 ± 0.81 vs. 1.69 ± 0.51), and blood-pool TBR (4.10 ± 1.17 vs. 2.99 ± 1.01) than false-positive lesions at the early time point (P, 0.01) and remained significant at the delayed time point, except for blood-pool TBR. Focal uptake (odds ratio, 12.07; 95% confidence interval, 2.98–48.80; P, 0.01) and subjective highest suspicion level (odds ratio, 10.91; 95% confidence interval, 1.19–99.69; P 5 0.03) correlated with true positivity. Using the receiver-operating-characteristic curve, optimal cutoffs for marrow TBR were 1.9 (area under the curve, 0.82) and 1.8 (area under the curve, 0.85) at early and delayed imaging, respectively. With these cutoffs, 15 of 17 malignant lesions were identified at both time points; however, fewer false-positive lesions were detected at the delayed time point (5/ 33) than at the early time point (11/33). Conclusion: True positivity of 18F-fluciclovine–targeted prostate biopsy in non–prostatectomytreated patients correlates with focal uptake, TBR (blood pool and marrow), and subjective highest suspicion level. A marrow TBR of 1.9 at the early time point and 1.8 at the delayed time point had optimal discriminating capabilities. Despite the relatively low intraprostate positive predictive value (34.0%) with 18F-fluciclovine, application of these parameters to interpretative criteria may improve true positivity in the treated prostate.

AB - We evaluated 18F-fluciclovine uptake parameters that correlate with true positivity for local recurrence in non–prostatectomy-treated patients. Methods: Twenty-one patients (prostate-specific antigen level, 7.4 ± 6.8 ng/mL) with biochemical recurrence after nonprostatectomy local therapy (radiotherapy and cryotherapy) underwent dual–time-point 18F-fluciclovine (364.1 ± 37.7 MBq) PET/CT from pelvis to diaphragm. Prostatic uptake over background was delineated and coregistered to a prostate-biopsy–planning ultrasound. Transrectal biopsies of 18F-fluciclovine–defined targets were completed using a 3-dimensional visualization and navigation platform. Histologic analyses of lesions were completed. Lesion characteristics including SUVmax, target-to-background ratio (TBR), uptake pattern, and subjective reader’s suspicion level were compared between true-positive (malignant) and false-positive (benign) lesions. Univariate analysis was used to determine the association between PET and histologic findings. Receiver-operating-characteristic curves were plotted to determine discriminatory cutoffs for TBR. Statistical significance was set at a P value of less than 0.05. Results: Fifty lesions were identified in 21 patients on PET. Seventeen of 50 (34.0%) targeted lesions in 10 of 21 patients were positive for malignancy. True-positive lesions had a significantly higher SUVmax (6.62 ± 1.70 vs. 4.92 ± 1.27), marrow TBR (2.57 ± 0.81 vs. 1.69 ± 0.51), and blood-pool TBR (4.10 ± 1.17 vs. 2.99 ± 1.01) than false-positive lesions at the early time point (P, 0.01) and remained significant at the delayed time point, except for blood-pool TBR. Focal uptake (odds ratio, 12.07; 95% confidence interval, 2.98–48.80; P, 0.01) and subjective highest suspicion level (odds ratio, 10.91; 95% confidence interval, 1.19–99.69; P 5 0.03) correlated with true positivity. Using the receiver-operating-characteristic curve, optimal cutoffs for marrow TBR were 1.9 (area under the curve, 0.82) and 1.8 (area under the curve, 0.85) at early and delayed imaging, respectively. With these cutoffs, 15 of 17 malignant lesions were identified at both time points; however, fewer false-positive lesions were detected at the delayed time point (5/ 33) than at the early time point (11/33). Conclusion: True positivity of 18F-fluciclovine–targeted prostate biopsy in non–prostatectomytreated patients correlates with focal uptake, TBR (blood pool and marrow), and subjective highest suspicion level. A marrow TBR of 1.9 at the early time point and 1.8 at the delayed time point had optimal discriminating capabilities. Despite the relatively low intraprostate positive predictive value (34.0%) with 18F-fluciclovine, application of these parameters to interpretative criteria may improve true positivity in the treated prostate.

KW - F-fluciclovine

KW - Prostate

KW - Recurrence

KW - Targeted biopsy

UR - http://www.scopus.com/inward/record.url?scp=85074377295&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074377295&partnerID=8YFLogxK

U2 - 10.2967/jnumed.119.227033

DO - 10.2967/jnumed.119.227033

M3 - Article

C2 - 30954940

AN - SCOPUS:85074377295

VL - 60

SP - 1531

EP - 1536

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

SN - 0161-5505

IS - 11

ER -