Value of 3-T Multiparametric Magnetic Resonance Imaging and Magnetic Resonance-Guided Biopsy for Early Risk Restratification in Active Surveillance of Low-Risk Prostate Cancer A Prospective Multicenter Cohort Study
Value of 3-T Multiparametric Magnetic Resonance Imaging and Magnetic Resonance-Guided Biopsy for Early Risk Restratification in Active Surveillance of Low-Risk Prostate Cancer A Prospective Multicenter Cohort Study
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DOI：
10.1097/rli.0000000000000008
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发表时间：
2014-03-01
影响因子：
6.7
通讯作者：
Barentsz, Jelle O.
中科院分区：
文献类型：
--
作者：
Hoeks, Caroline M. A.;Somford, Diederik M.;Barentsz, Jelle O.
本研究的目的是评估3- t多参数磁共振成像（MP-MRI）和磁共振引导活检（MRGB）在主动监测患者3个月和12个月随访时的早期风险再确认中的作用。材料与方法在参与一项大型主动监测试验的4家医院中，启动了一项辅助研究。在4家参与研究的医院中，有1家在前列腺癌诊断后3个月和12个月分别进行盆腔磁共振成像、前列腺MP-MRI和MRGB检查（仅后一种前列腺MP-MRI和MRGB）。采用前列腺成像报告和数据系统（PI-RADS）评分在前列腺MP-MRI上确定癌症可疑区域（CSRs）。主动监测中断的风险调整标准是(1)经组织病理学证实的磁共振成像怀疑淋巴结/骨转移和/或(2)MP-MRI上CSR的MRGB标本中Gleason生长模式（GGP） 4和/或5和/或癌症多灶性（>= 3灶）。结果从2009年到2012年，82例患者中有64例被连续和前瞻性纳入，并接受了MP-MRI和随后的MRGB检查。在随访3个月和12个月时，14%（9/64）和10%（3/30）的患者在MP-MRI和MRGB的基础上进行了风险重组。总体CSR PI-RADS评分为1或2时，MRGB检测任何前列腺癌的阴性预测值分别为84%（38/45）和100%(45/45)，用于检测含有GGP 4或5的癌症。CSR PI-RADS评分为4分或更高，对于MRGB检测含有ggp4或5的癌症的敏感性为92%（11/12）。结论应用MP-MRI和MRGB进行主动监测有助于在随访3个月时早期发现ggp4或ggp5伴癌患者。如果在进一步的随访中，PI-RADS评分为1或2仍然对含有GGP 4或5的癌症具有阴性预测值，则PI-RADS标准化报告的MP-MRI可能是选择适合主动监测的前列腺癌患者的有前途的工具。
ObjectivesThe objective of this study was to evaluate the role of 3-T multiparametric magnetic resonance imaging (MP-MRI) and magnetic resonance-guided biopsy (MRGB) in early risk restratification of patients on active surveillance at 3 and 12 months of follow-up.Materials and MethodsWithin 4 hospitals participating in a large active surveillance trial, a side study was initiated. Pelvic magnetic resonance imaging, prostate MP-MRI, and MRGB were performed at 3 and 12 months (latter prostate MP-MRI and MRGB only) after prostate cancer diagnosis in 1 of the 4 participating hospitals. Cancer-suspicious regions (CSRs) were defined on prostate MP-MRI using Prostate Imaging Reporting And Data System (PI-RADS) scores.Risk restratification criteria for active surveillance discontinuance were (1) histopathologically proven magnetic resonance imaging suspicion of node/bone metastases and/or (2) a Gleason growth pattern (GGP) 4 and/or 5 and/or cancer multifocality (>= 3 foci) in MRGB specimens of a CSR on MP-MRI.ResultsFrom 2009 to 2012, a total of 64 of 82 patients were consecutively and prospectively included and underwent MP-MRI and a subsequent MRGB. At 3 and 12 months of follow-up, 14% (9/64) and 10% (3/30) of the patients were risk-restratified on the basis of MP-MRI and MRGB. An overall CSR PI-RADS score of 1 or 2 had a negative predictive value of 84% (38/45) for detection of any prostate cancer and 100% (45/45) for detection of a GGP 4 or 5 containing cancer upon MRGB, respectively. A CSR PI-RADS score of 4 or higher had a sensitivity of 92% (11/12) for detection of a GGP 4 or 5 containing cancer upon MRGB.ConclusionsApplication of MP-MRI and MRGB in active surveillance may contribute in early identification of patients with GGP 4 or 5 containing cancers at 3 months of follow-up. If, during further follow-up, a PI-RADS score of 1 or 2 continues to have a negative predictive value for GGP 4 or 5 containing cancers, a PI-RADS standardized reported MP-MRI may be a promising tool for the selection of prostate cancer patients suitable for active surveillance.