The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: recommendations from a consensus panel
The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: recommendations from a consensus panel
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DOI：
10.1111/bju.12243
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发表时间：
2014-02-01
影响因子：
4.5
通讯作者：
Marberger, Michael
中科院分区：
文献类型：
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作者：
Muller, Berrend G.;Futterer, Jurgen J.;Marberger, Michael
目的建立多参数磁共振成像（mpMRI）在鉴别病灶治疗患者中的应用共识。方法来自欧洲和北美的外科医生、放射科医生和基础研究人员参加了关于mpMRI在前列腺癌局灶治疗中的应用的共识会议。协商一致的过程是面对面的，在可能的情况下，提出和讨论具体的临床问题并寻求一致意见。所有参与者均列在作者之列。具体来说，主题不包括前列腺癌的分期，而是确定进行MRI的最佳要求，以及最佳mpMRI的现状，以确定前列腺癌的病灶（例如定位0.5mL的小目标病变），（ii）监测和评估局灶消融治疗的结果，（iii）确定新的MRI方法的诊断优势。此外，如果有高质量的mpMRI，我们还讨论了在选择局灶治疗患者时是否需要经会阴模板饱和活检。换句话说，mpMRI能否取代经会阴饱和活检在患者选择局灶治疗中的作用？会议在大多数关键方面达成了共识；然而，在mpMRI的最佳要求的定义上，有一个反对的声音。如果在高质量的机器上（带/不带直肠内线圈的3T或带直肠内线圈的1.5T）并由经验丰富的放射科医生判断，mpMRI是实现局灶治疗所需目标的最佳方法。结构化和标准化的前列腺MRI报告是至关重要的。最先进的mpMRI能够定位小肿瘤进行局灶治疗。最先进的mpMRI是局灶性消融随访的首选技术。结论MRI在局灶性治疗中的应用证据有限。mpMRI对肿瘤侵袭性的分级不够准确。当高质量的mpMRI可用时，模板引导的饱和活检不再是必要的；然而，可疑病变总是应通过（有针对性的）活检证实。
ObjectiveTo establish a consensus on the utility of multiparametric magnetic resonance imaging (mpMRI) to identify patients for focal therapy.MethodsUrological surgeons, radiologists, and basic researchers, from Europe and North America participated in a consensus meeting about the use of mpMRI in focal therapy of prostate cancer.The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. All participants are listed among the authors.Topics specifically did not include staging of prostate cancer, but rather identifying the optimal requirements for performing MRI, and the current status of optimally performed mpMRI to (i) determine focality of prostate cancer (e.g. localising small target lesions of 0.5mL), (ii) to monitor and assess the outcome of focal ablation therapies, and (iii) to identify the diagnostic advantages of new MRI methods.In addition, the need for transperineal template saturation biopsies in selecting patients for focal therapy was discussed, if a high quality mpMRI is available. In other words, can mpMRI replace the role of transperineal saturation biopsies in patient selection for focal therapy?ResultsConsensus was reached on most key aspects of the meeting; however, on definition of the optimal requirements for mpMRI, there was one dissenting voice.mpMRI is the optimum approach to achieve the objectives needed for focal therapy, if made on a high quality machine (3T with/without endorectal coil or 1.5T with endorectal coil) and judged by an experienced radiologist.Structured and standardised reporting of prostate MRI is paramount.State of the art mpMRI is capable of localising small tumours for focal therapy.State of the art mpMRI is the technique of choice for follow-up of focal ablation.ConclusionsThe present evidence for MRI in focal therapy is limited.mpMRI is not accurate enough to consistently grade tumour aggressiveness.Template-guided saturation biopsies are no longer necessary when a high quality state of the art mpMRI is available; however, suspicious lesions should always be confirmed by (targeted) biopsy.