Multiparameric magnetic resonance imaging vs. standard care in men being evaluated for prostate cancer: A randomized study
Multiparameric magnetic resonance imaging vs. standard care in men being evaluated for prostate cancer: A randomized study
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DOI：
10.1016/j.urolonc.2014.09.013
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发表时间：
2015-01-01
影响因子：
2.7
通讯作者：
Catalano, Carlo
中科院分区：
文献类型：
--
作者：
Panebianco, Valeria;Barchetti, Flavio;Catalano, Carlo
目的：评估随机接受多参数磁共振成像(MP-MRI)/活检的男性前列腺癌(PCa)患者的比例是否高于随机接受经直肠超声(TRUS)引导活检的患者。方法：共有1140例具有高度提示前列腺癌症状的患者被分成两组，每组570例，分别采用两种不同的诊断算法。A组在TRUS引导下进行随机活检。B组接受MP-MRI和TRUS引导下的靶向+随机活检。以前列腺癌切除为标准，计算MP-MRI诊断前列腺癌的准确性。其余355名患者接受了MP-MRI检查：208名患者为阳性，147名患者表现不明显。在第二次随机+靶向活检后，208例患者中有186例检测到了前列腺癌。B组440例NIP-MRI阳性，417例首次活检发现PCa，13例MP-MRI和活检均未见明显改变。B组130例，在MP-MRI和活检均无明显改变的患者中，饱和活检后PCAGleason评分为6或癌前病变。MP-MRI对PCa的诊断准确率为97%。结论：与TRUS引导的活检相比，MP-MRI/Hiopsy组中有临床意义的PCa的男性比例更高，而且MP-MRI是一种非常可靠的工具，可以确定患者是否需要进行积极的监测。(C)2014 Elsevier Inc.保留所有权利。
Objectives: To assess whether the proportion of men with clinically significant prostate cancer (PCa) is higher among men randomized to multiparametric magnetic resonance imaging (mp-MRI)/biopsy vs. those randomized to transrectal ultrasound (TRUS)-guided biopsy.Methods: In total, 1,140 patients with symptoms highly suggestive of PCa were enrolled and divided in 2 groups of 570 patients to follow 2 different diagnostic algorithms. Group A underwent a TRUS-guided random biopsy. Group B underwent an mp-MRI and a TRUS-guided targeted + random biopsy. The accuracy of mp-MRI in the diagnosis of PCa was calculated using prostatectomy as the standard of reference.Results: In group A, PCa was detected in 215 patients. The remaining 355 patients underwent an mp-MRI: the findings were positive in 208 and unremarkable in 147 patients. After the second random + targeted biopsy, PCa was detected in 186 of the 208 patients. In group B, 440 patients had positive findings on nip-MRI, and PCa was detected in 417 at first biopsy; 13() group B patients had unremarkable findings on both mp-MRI and biopsy. In the 130 group B patients with unremarkable findings on mp-MRI and biopsy, a PCa Gleason score of 6 or precancerous lesions were detected after saturation biopsy. mp-MRI showed an accuracy of 97% for the diagnosis of PCa.Conclusions: The proportion of men with clinically significant PCa is higher among those randomized to mp-MRI/hiopsy vs. those randomized to TRUS-guided biopsy; moreover, mp-MRI is a very reliable tool to identify patients to schedule in active surveillance. (C) 2014 Elsevier Inc. All rights reserved.