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Purpose <p>The aim of this study was to investigate the radiological and pathological characteristics of false-positive lesions on [<sup>68</sup>Ga]Ga-PSMA-11 PET/CT during the primary staging of prostate cancer.</p> Methods <p>This study retrospectively analyzed 216 prostate cancer patients who had [<sup>68</sup>Ga]Ga-PSMA-11 PET/CT before radical prostatectomy. False-positive lesion was defined as suspicious lesion with PRIMARY score ≥ 3 on PET/CT but benign on whole-mount pathology. To analyze the radiological and pathological features of false-positive lesions, no-uptake areas on PSMA PET/CT with benign pathology on the whole-mount specimen were randomly delineated and defined as true-negative lesions. The pathological features of false-positive and true-negative lesions were compared using Fisher’s exact test. The differences of SUVmax and SUVmean between false-positive and true-positive lesions were determined and compared using the Wilcoxon matched-pairs signed-ranks test. In addition, PSMA expression in false-positive lesions was assessed by immunohistochemistry.</p> Results <p>A total of 36 false-positive lesions were identified on [<sup>68</sup>Ga]Ga-PSMA-11 PET/CT: 25 (69.44%) were simple atrophy with cyst formation, 7 (19.44%) were prostatic nodular hyperplasia, 3 (8.33%) were inflammation and 1 (2.78%) was normal glands. A comparable number of 36 true-negative lesions were delineated: 21 (58.33%) were normal glands, 8 (22.22%) were simple atrophy with cyst formation, 6 (16.67%) were prostatic nodular hyperplasia, and 1 (2.78%) were inflammation. The Fisher’s exact test revealed a statistically significant difference in the prevalence of simple atrophy with cyst formation between false-positive and true-negative lesions (69.44% vs. 22.22%; <i>P</i> &lt; 0.001). Differences in SUVmax and SUVmean between false-positive and true-positive lesions were also statistically significant (both <i>P</i> &lt; 0.001). PSMA expression in false-positive lesions was confirmed via immunohistochemistry.</p> Conclusion <p>This study determined that simple atrophy with cyst formation is a distinctive pathological feature of false-positive lesions on [<sup>68</sup>Ga]Ga-PSMA-11 PET/CT. This observation is likely attributable to the elevated PSMA expression in simple atrophy with cyst formation, as confirmed by histological analysis. Additionally, false-positive lesions were found to have significantly lower SUV compared to true-positive lesions.</p>

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Pathological and radiological features of false-positive lesions on [68Ga]Ga-PSMA-11 PET/CT in primary staging of prostate cancer: a radio-pathology matching analysis

  • 期刊论文

  • 发表日期：

    2025年2月17日

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  • Renjie Li,
  • Yao Fu,
  • Shan Peng,
  • Fengjiao Yang,
  • Shuyue Ai,
  • Feng Wang,
  • Shun Zhang,
  • Hongqian Guo,
  • Xuefeng Qiu

摘要

Purpose

The aim of this study was to investigate the radiological and pathological characteristics of false-positive lesions on [68Ga]Ga-PSMA-11 PET/CT during the primary staging of prostate cancer.

Methods

This study retrospectively analyzed 216 prostate cancer patients who had [68Ga]Ga-PSMA-11 PET/CT before radical prostatectomy. False-positive lesion was defined as suspicious lesion with PRIMARY score ≥ 3 on PET/CT but benign on whole-mount pathology. To analyze the radiological and pathological features of false-positive lesions, no-uptake areas on PSMA PET/CT with benign pathology on the whole-mount specimen were randomly delineated and defined as true-negative lesions. The pathological features of false-positive and true-negative lesions were compared using Fisher’s exact test. The differences of SUVmax and SUVmean between false-positive and true-positive lesions were determined and compared using the Wilcoxon matched-pairs signed-ranks test. In addition, PSMA expression in false-positive lesions was assessed by immunohistochemistry.

Results

A total of 36 false-positive lesions were identified on [68Ga]Ga-PSMA-11 PET/CT: 25 (69.44%) were simple atrophy with cyst formation, 7 (19.44%) were prostatic nodular hyperplasia, 3 (8.33%) were inflammation and 1 (2.78%) was normal glands. A comparable number of 36 true-negative lesions were delineated: 21 (58.33%) were normal glands, 8 (22.22%) were simple atrophy with cyst formation, 6 (16.67%) were prostatic nodular hyperplasia, and 1 (2.78%) were inflammation. The Fisher’s exact test revealed a statistically significant difference in the prevalence of simple atrophy with cyst formation between false-positive and true-negative lesions (69.44% vs. 22.22%; P < 0.001). Differences in SUVmax and SUVmean between false-positive and true-positive lesions were also statistically significant (both P < 0.001). PSMA expression in false-positive lesions was confirmed via immunohistochemistry.

Conclusion

This study determined that simple atrophy with cyst formation is a distinctive pathological feature of false-positive lesions on [68Ga]Ga-PSMA-11 PET/CT. This observation is likely attributable to the elevated PSMA expression in simple atrophy with cyst formation, as confirmed by histological analysis. Additionally, false-positive lesions were found to have significantly lower SUV compared to true-positive lesions.