The PICTURE study: diagnostic accuracy of multiparametric MRI in men requiring a repeat prostate biopsy
The PICTURE study: diagnostic accuracy of multiparametric MRI in men requiring a repeat prostate biopsy
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DOI：
10.1038/bjc.2017.57
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发表时间：
2017-04-01
影响因子：
8.8
通讯作者：
Ahmed, Hashim U.
中科院分区：
文献类型：
--
作者：
Simmons, Lucy A. M.;Kanthabalan, Abi;Ahmed, Hashim U.
背景：经直肠前列腺活检诊断的准确性有限。前列腺成像与经会阴超声引导活检对前列腺癌风险评估（PICTURE）的比较是一项配对队列验证性研究，旨在评估多参数磁共振成像（mpMRI）对需要重复活检的男性的诊断准确性。方法：所有患者均行3t mpMRI和经会阴模板前列腺定位活检（TTPM活检）。多参数MRI报告使用李克特评分，放射科医生对初始活检不知情。男性对mpMRI结果不知情。临床上明显的前列腺癌定义为Gleason >= 4+3和/或癌核长度>= 6 mm。结果：249例患者均进行了这两项检查，平均（s.d）年龄为62(7)岁，PSA中位数（IQR）为6.8 ng ml(4.98-9.50)，既往活检中位数（IQR）为1(1-2)，平均（s.d）腺体大小为37 ml（15.5）。在TTPM活检中，103例（41%）有临床意义的前列腺癌。214例（86%）前列腺mpMRI阳性，Likert评分>= 3；敏感性97.1%(95%置信区间（CI）： 92 ~ 99)，特异性21.9%(15.5 ~ 29.5)，阴性预测值（NPV） 91.4%(76.9 ~ 98.1)，阳性预测值（PPV） 46.7%（35.2 ~ 47.8）。mpMRI阳性129例（51.8%），Likert评分>= 4；敏感性80.6%(71.6 ~ 87.7)，特异性68.5% (60.3 ~ 75.9),NPV 83.3% (75.4 ~ 89.5), PPV 64.3%（55.4 ~ 72.6）。结论：对于建议进行重复前列腺活检的男性，前列腺mpMRI可以安全地避免重复活检，对临床重要癌症具有高敏感性。然而，这种策略可能会错过一些重要的癌症，并过度诊断无关紧要的癌症，这取决于用于确定哪些男性应该进行活检的mpMRI评分阈值。
Background: Transrectal prostate biopsy has limited diagnostic accuracy. Prostate Imaging Compared to Transperineal Ultrasound-guided biopsy for significant prostate cancer Risk Evaluation (PICTURE) was a paired-cohort confirmatory study designed to assess diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) in men requiring a repeat biopsy.Methods: All underwent 3 T mpMRI and transperineal template prostate mapping biopsies (TTPM biopsies). Multiparametric MRI was reported using Likert scores and radiologists were blinded to initial biopsies. Men were blinded to mpMRI results. Clinically significant prostate cancer was defined as Gleason >= 4+3 and/or cancer core length >= 6 mm.Results: Two hundred and forty-nine had both tests with mean (s.d.) age was 62 (7) years, median (IQR) PSA 6.8 ng ml (4.98-9.50), median (IQR) number of previous biopsies 1 (1-2) and mean (s.d.) gland size 37 ml (15.5). On TTPM biopsies, 103 (41%) had clinically significant prostate cancer. Two hundred and fourteen (86%) had a positive prostate mpMRI using Likert score >= 3; sensitivity was 97.1% (95% confidence interval (CI): 92-99), specificity 21.9% (15.5-29.5), negative predictive value (NPV) 91.4% (76.9-98.1) and positive predictive value (PPV) 46.7% (35.2-47.8). One hundred and twenty-nine (51.8%) had a positive mpMRI using Likert score >= 4; sensitivity was 80.6% (71.6-87.7), specificity 68.5% (60.3-75.9), NPV 83.3% (75.4-89.5) and PPV 64.3% (55.4-72.6).Conclusions: In men advised to have a repeat prostate biopsy, prostate mpMRI could be used to safely avoid a repeat biopsy with high sensitivity for clinically significant cancers. However, such a strategy can miss some significant cancers and overdiagnose insignificant cancers depending on the mpMRI score threshold used to define which men should be biopsied.