Combining prostate health index and multiparametric magnetic resonance imaging in the diagnosis of clinically significant prostate cancer in an Asian population
Combining prostate health index and multiparametric magnetic resonance imaging in the diagnosis of clinically significant prostate cancer in an Asian population
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DOI：
10.1007/s00345-019-02889-2
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发表时间：
2020-05-01
影响因子：
3.4
通讯作者：
Wu, Hsi-Chin
中科院分区：
文献类型：
--
作者：
Hsieh, Po-Fan;Li, Wei-Juan;Wu, Hsi-Chin
目的 评估结合前列腺健康指数（PHI）和多参数磁共振成像（mpMRI）检测亚洲人群中具有临床意义的前列腺癌（csPC）的实用性。患者和方法 我们前瞻性地招募了因血清前列腺特异性抗原升高（PSA > 4 ng/mL）和/或直肠指检异常而在三级转诊中心接受前列腺活检的患者。在前列腺活检之前，对血清样本进行 PSA、游离 PSA 和 p2PSA 检测，以计算 PHI。此外，mpMRI 是使用 3-T 扫描仪进行的，并在前列腺成像报告和数据系统版本 2 (PI-RADS v2) 中进行报告。对 PHI、mpMRI 以及两者组合的诊断性能进行了评估。结果 102 例受试者中，39 例（38.2%）被诊断为 PC，其中 24 例（23.5%）为 csPC（Gleason ≥ 7）。以PI-RADS≥3为阈值，预测csPC的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为100%、44.9%、35.8%和100%。以 PHI >= 30 为阈值，预测 csPC 的敏感性、特异性、PPV 和 NPV 分别为 91.7%、43.6%、33.3% 和 94.4%。结合 PHI 和 mpMRI 的受试者工作特征曲线下面积大于单独使用 PHI（0.873 vs. 0.735，p = 0.002）和单独使用 mpMRI（0.873 vs. 0.830，p = 0.035）。如果活检仅限于 PI-RADS 5 以及 PI-RADS 3 或 4 且 PHI >= 30 的患者，则可以避免 50% 的活检，而漏掉一名 csPC 患者。结论 在亚洲人群中，与单独使用 PHI 或 mpMRI 相比，PHI 和 mpMRI 组合检测 csPC 的准确性更高。
Objective To evaluate the practicability of combining prostate health index (PHI) and multiparametric magnetic resonance imaging (mpMRI) for the detection of clinically significant prostate cancer (csPC) in an Asian population. Patients and methods We prospectively enrolled patients who underwent prostate biopsy due to elevated serum prostate-specific antigen (PSA > 4 ng/mL) and/or abnormal digital rectal examination in a tertiary referral center. Before prostate biopsy, the serum samples were tested for PSA, free PSA, and p2PSA to calculate PHI. Besides, mpMRI was performed using a 3-T scanner and reported in the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2). The diagnostic performance of PHI, mpMRI, and combination of both was assessed. Result Among 102 subjects, 39 (38.2%) were diagnosed with PC, including 24 (23.5%) with csPC (Gleason >= 7). By the threshold of PI-RADS >= 3, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to predict csPC were 100%, 44.9%, 35.8%, and 100%, respectively. By the threshold of PHI >= 30, the sensitivity, specificity, PPV, and NPV to predict csPC were 91.7%, 43.6%, 33.3%, and 94.4%, respectively. The area under the receiver operator characteristic curve of combining PHI and mpMRI was greater than that of PHI alone (0.873 vs. 0.735, p = 0.002) and mpMRI alone (0.873 vs. 0.830, p = 0.035). If biopsy was restricted to patients with PI-RADS 5 as well as PI-RADS 3 or 4 and PHI >= 30, 50% of biopsy could be avoided with one csPC patient being missed. Conclusion The combination of PHI and mpMRI had higher accuracy for detection of csPC compared with PHI or mpMRI alone in an Asian population.