Table 3. Effectiveness of Enhanced CT, 68Ga-PSMA-11 and 18F-FDG PET/CT Parameters for Identifying the Pathological Features of ccRCC Patients by ROC Curve Analysis.
| Pathological features (positive vs. negative) | Radiological parameters | AUC (95%CI) | Cutoff value | Sensitivity | Specificity | PPV | NPV | P value |
|---|---|---|---|---|---|---|---|---|
| Tumor necrosis | CT value | 0.57(0.42-0.73) | 94.00 | 1.00 | 0.20 | 0.22 | 1.00 | 0.221 |
| SUVmax (68Ga-PSMA-11 PET/CT) | 0.85(0.76-0.94) | 25.26 | 1.00 | 0.75 | 0.46 | 1.00 | <0.001 | |
| SUVmax (18F-FDG PET/CT) | 0.64(0.48-0.79) | 4.54 | 0.77 | 0.59 | 0.29 | 0.92 | 0.119 | |
| Sarcomatoid or rhabdoid feature | CT value | 0.62(0.42-0.82) | 118.00 | 1.00 | 0.35 | 0.12 | 1.00 | 0.262 |
| SUVmax(68Ga-PSMA-11 PET/CT)a | 0.91(0.84-0.98) | 30.58 | 1.00 | 0.83 | 0.35 | 1.00 | <0.001 | |
| SUVmax(18F-FDG PET/CT)a | 0.75(0.61-0.90) | 4.52 | 1.00 | 0.56 | 0.17 | 1.00 | 0.038 | |
| Adverse pathology* | CT value | 0.57(0.43-0.72) | 94.00 | 1.00 | 0.22 | 0.28 | 1.00 | 0.179 |
| SUVmax(68Ga-PSMA-11 PET/CT)b | 0.90(0.83-0.97) | 25.26 | 1.00 | 0.80 | 0.61 | 1.00 | <0.001 | |
| SUVmax(18F-FDG PET/CT)b | 0.66(0.52-0.79) | 4.52 | 0.82 | 0.62 | 0.40 | 0.92 | 0.049 |
a
SUVmax(68Ga-PSMA-11 PET/CT) vs. SUVmax(18F-FDG PET/CT) in distinguishing sarcomatoid or rhabdoid feature (Delong test, z=1.998, p=0.046)
b
SUVmax(68Ga-PSMA-11 PET/CT) vs. SUVmax(18F-FDG PET/CT) in distinguishing adverse pathology (Delong test, z=3.433, p<0.001)
*
Adverse pathology is defined as tumor presenting with necrosis or a sarcomatoid or rhabdoid feature
Units: CT value, Hu ccRCC = clear-cell renal cell carcinoma; CT = computed tomography; SUVmax = maximum standardized uptake value; AUC = area under the ROC curve; CI = confidence interval; PPV = positive predictive value; NPV = negative predictive value