Experience improves staging accuracy of endorectal magnetic resonance imaging in prostate cancer: what is the learning curve?
Experience improves staging accuracy of endorectal magnetic resonance imaging in prostate cancer: what is the learning curve?
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经验提高了前列腺癌直肠内磁共振成像分期的准确性：学习曲线是怎样的？
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发表时间：
2007
期刊：
影响因子：
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通讯作者：
J. Corman
中科院分区：
文献类型：
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作者：
K. Latchamsetty;L. Borden;C. Porter;M. Lacrampe;M. Vaughan;E. Lin;N. Conti;J. Wright;J. Corman
介绍
准确的临床分期对指导前列腺癌患者的治疗至关重要。直肠内磁共振成像（MRI）已被提倡，以提高分期的准确性。为了评估直肠内MRI解释的学习曲线，我们比较了两组高危前列腺患者，这些患者在一个既往暴露于该成像模式有限的中心接受直肠内MRI。
材料和方法
前瞻性收集所有接受术前直肠内MRI和根治性直肠癌切除术的患者的数据。根据活检Gleason评分、前列腺特异性抗原水平和直肠指检高度怀疑囊外疾病的患者，或者如果Memorial Sloan-Kettering诺模图预测囊外疾病的可能性大于30%的患者，则进行MRI。我们的前40名患者（第1组）和我们的第二个40名患者（第2组）的MRI结果进行了比较，以评估改善。
结果
在2003年10月至2005年9月期间，80名患者接受了直肠内MRI，随后进行了根治性直肠切除术。平均年龄和中位PSA分别为58.4（范围43 - 74）和6.4（范围0.048 - 115.0）。将MRI结果与根治性直肠癌切除术标本的病理结果进行比较。第1组与第2组检测囊外疾病的敏感性、特异性、阳性预测值和阴性预测值分别为31.3%与64.7%、70.8%与78.3%、41.7%与68.8%和60.7%与75.0%。第1组MRI检测囊外扩张的准确性为52.5%，第2组为72.5%。
结论
在我们的系列研究中，直肠内MRI最初不能准确预测前列腺癌患者的肿瘤分期。随着进一步的经验，MRI的准确性大大提高，并接近在直肠内前列腺MRI解释方面具有丰富经验的中心的结果。
INTRODUCTION
Accurate clinical staging is critical in guiding treatment for patients with prostate adenocarcinoma. Endorectal magnetic resonance imaging (MRI) has been advocated to improve staging accuracy. In order to assess the learning curve for endorectal MRI interpretation, we compared two cohorts of patients with high-risk prostate who underwent endorectal MRI at a center with limited prior exposure to this imaging modality.
MATERIALS AND METHODS
Data for all patients who received a preoperative endorectal MRI followed by radical prostatectomy were prospectively collected. MRI was performed in patients with a high level of suspicion for extracapsular disease based on biopsy Gleason score, prostate specific antigen level, and digital rectal examination or if the Memorial Sloan-Kettering nomogram predicted a greater than 30% likelihood of extracapsular disease. The MRI results of our first 40 patients (group 1) and our second 40 patients (group 2) were compared to assess for improvement.
RESULTS
Between October 2003 and September 2005, 80 patients underwent an endorectal MRI followed by radical prostatectomy. Mean age and median PSA were 58.4 (range 43 - 74) and 6.4 (range 0.048 -115.0), respectively. MRI findings were compared to the pathological findings from the radical prostatectomy specimen. Sensitivity, specificity, positive predictive value, and negative predictive value for detection of extracapsular disease were 31.3% versus 64.7%, 70.8% versus 78.3%, 41.7% versus 68.8%, and 60.7% versus 75.0%, respectively in group 1 versus group 2. The accuracy of MRI for detecting extracapsular extension was 52.5% in group 1 compared to 72.5% in group 2.
CONCLUSIONS
In our series, endorectal MRI initially did not accurately predict tumor stage in patients with prostatic adenocarcinoma. With further experience, the accuracy of MRI substantially improved and approached the results from centers with significant experience in the interpretation of endorectal prostate MRI.