正子攝影中攝護腺偶見瘤之臨床意義：系統性回顧及統合分析

蘇永濬¹、黃永成²、曾文歆^3,4、林宗緯⁵、簡維辰⁶、蘇孝濬⁷、江亭易^3*

¹高雄醫學大學附設中和紀念醫院 泌尿科；²高雄長庚紀念醫院 核子醫學部；³台南永康奇美醫院 外科部 泌尿科；⁴國立中山大學生物醫學研究所；⁵高雄長庚紀念醫院 教學部；⁶國立臺灣大學醫學院附設醫院 教學部；⁷高雄醫學大學 醫學院 醫學系

Significance of incidental focal 18F-FDG PET/CT uptake in the prostate gland: A Systematic review and meta-analysis

Yung-Chun Su¹, Yung-Cheng Huang² , Wen-Hsin Tseng^3,4, Chung-Wei Lin⁵, Wei-Chen Chien⁶, Hsiao-Chun Su⁷, Ting-Yi Chiang^3*

¹ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;

² Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;

³ Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

⁴ Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan;

⁵ Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;

⁶ Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan;

⁷School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Purpose:

  Prostate cancer (PCa) is a significant health concern, with advanced imaging modalities like positron emission tomography (PET) playing a pivotal role in its detection. Prostatic incidental uptake (PIU) of fluorodeoxyglucose(FDG) on PET has garnered attention, yet its prevalence, risk factors, and characteristics remain unclear. Our study aims to systematically review and meta-analyze the extant literature to elucidate these aspects.

Materials and Methods:

  Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted up to June, 2023 across multiple databases. Studies reporting on PIU on FDG PET were included. Data extraction and risk of bias assessment were performed independently by two reviewers. Pooled analyses were conducted to determine prevalence, risk factors, and characteristics of PIU.

Results:

  Among 2,056 identified records, 17 studies met the eligibility criteria for qualitative synthesis, and 14 of them were selected for meta-analysis. The pooled prevalence of PIU among 192,036 patients was 1.5% (95% confidence interval [CI]: 1.1 to 2.0%), with substantial heterogeneity among studies. Of all patients undergone further evaluation, 22.4% (95% CI: 16.1 to 30.3%) exhibited malignant results, while 56.0% (95% CI: 45.0 to 66.4%) of those undergone biopsy demonstrated malignancy. Older age, elevated prostate-specific antigen (PSA) level, higher maximum standardized uptake value (SUVmax), and an inclination to FDG uptake in the peripheral zone of the prostate were identified as potential predictors of malignancy.

Conclusion:

  Our study provides valuable insights into the prevalence, risk factors, and characteristics of PIU on FDG PET. Despite limitations such as heterogeneity among studies and publication bias, standardizing diagnostic criteria holds promise for improving diagnostic accuracy and patient outcomes in terms of the management of PIU.