Preoperative Staging of Invasive Bladder Cancer With Dynamic Gadolinium-enhanced Magnetic Resonance Imaging: Results From a Prospective Study
Preoperative Staging of Invasive Bladder Cancer With Dynamic Gadolinium-enhanced Magnetic Resonance Imaging: Results From a Prospective Study
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DOI：
10.1016/j.urology.2012.07.056
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发表时间：
2012-12-01
期刊：
影响因子：
2.1
通讯作者：
Dobos, Nora
中科院分区：
文献类型：
--
作者：
Daneshmand, Siamak;Ahmadi, Hamed;Dobos, Nora
目的评价动态钆增强磁共振成像（DGE-MRI）检测膀胱外膀胱癌（BC）和淋巴结阳性疾病的侵袭性BC患者的准确性。材料与方法在2004年至2009年的前瞻性单中心研究中，临床浸润性BC，谁是根治性手术的候选人，患者进行术前DGE-MRI。由2名MRI专家确定放射学T和N分期，并计算观察者之间的一致性。的敏感性，特异性，阳性和阴性预测值，和准确性的放射学分期在区分淋巴结阴性器官局限性与非器官局限性的BC和阴性与阳性淋巴结疾病进行了测定，并与术后病理分期作为参考标准methods.RESULTS一个共122例（72名男性），平均年龄为67.8岁。病理检查显示80/122例（65.5%）浸润性BC，其中pT 4期15/122例（12.3%），pT 3期27/122例（22.1%），pT 2期38/122例（31.1%），27例（22.1%）患者有淋巴结阳性疾病。根据Kappa评分，观察者间T和N分期的一致性分别为0.44和0.49。DGE-MRI在区分淋巴结阴性器官局限性和非器官局限性BC的敏感性，特异性和准确性分别为87.5%，47.6%和74%，阳性淋巴结疾病的检测分别为40.7%，91.5%和80.3%，respectively.CONCLUSION我们提出了最大的队列浸润性BC患者进行术前DGE-MRI的结果。尽管DGE-MRI改善了浸润性BC的T和N分期，但它仍然不是理想的模式，需要标准化的方案来解释成像结果。泌尿学80：1313 e1318，2012。(C)2012 Elsevier Inc.
OBJECTIVE To evaluate the accuracy of dynamic gadolinium-enhanced magnetic resonance imaging (DGE-MRI) to detect extravesical bladder cancer (BC) and lymph node-positive disease in patients with invasive BC.MATERIAL AND METHODS In a prospective single-center study from 2004 to 2009, patients with clinically invasive BC, who were candidates for curative surgery, underwent preoperative DGE-MRI. Radiologic T and N staging was determined by 2 MRI expert radiologists, and the interobserver agreement was calculated. The sensitivity, specificity, positive and negative predictive values, and accuracy of radiologic staging in differentiating lymph node-negative organ-confined vs nonorgan-confined BC and negative vs positive nodal disease was determined and compared with the postoperative pathologic staging as the reference standard method.RESULTS A total of 122 patients (72 men) with a mean age of 67.8 years were included. Pathologic examination revealed invasive BC in 80/122 (65.5%), including stage pT4 in 15/122 (12.3%), pT3 in 27/122 (22.1%), and pT2 in 38/122 (31.1%), and 27 patients (22.1%) had node-positive disease. The interobserver agreement for T and N staging according to the kappa score was 0.44 and 0.49, respectively. The sensitivity, specificity, and accuracy of DGE-MRI in differentiating lymph node-negative organ-confined from nonorgan-confined BC was 87.5%, 47.6%, and 74% and for the detection of positive nodal disease was 40.7%, 91.5%, and 80.3%, respectively.CONCLUSION We have presented the results of the largest cohort of patients with invasive BC underwent preoperative DGE-MRI. Although DGE-MRI improved T and N staging of invasive BC, it is still not the ideal modality and needs a standardized protocol for interpretation of the imaging findings. UROLOGY 80: 1313e1318, 2012. (C) 2012 Elsevier Inc.