Evaluation of magnetic resonance imaging and targeted biopsy: The difficulty of finding the right reference standard
Evaluation of magnetic resonance imaging and targeted biopsy: The difficulty of finding the right reference standard
复制标题
磁共振成像和靶向活检的评估：寻找正确参考标准的困难
作者：
Berg S;Fletcher SA;Cole AP;Trinh QD
我们饶有兴趣地阅读了Truong等人的研究，提出了一种新的工具，用于预测先前阴性的12核系统活检后的良性前列腺病理。在纳入的285名患者中，尽管有异常的磁共振成像(MRI)，但46.3%的患者在靶向活检后仍有良性组织学发现。这些都被定义为“假阳性”核磁共振成像1。这种方法突出了评估靶向活检最具挑战性和最具争议的方面--确定明确的参考标准。由于靶向活检是在跨学科的环境中使用的，所有参与其中的医生(泌尿科医生、放射科医生、病理学家等)有一个特殊的学习曲线，在解释其结果时必须与不确定性作斗争。在最近的一项研究中阐明了这一点，该研究表明放射科医生、泌尿科医生以及技术差异可能会影响靶向活检结果3。换句话说，使用靶向活检结果作为参考标准具有明显的局限性。如果前列腺MRI显示可疑病变，而随后的靶向活检发现良性组织学结果，理论上有两个可能的错误来源：PI-RADS评分错误高或靶向活检未能准确采样相关病变。为了强调这一点，卡什等人。分析了61名MRI表现可疑的患者的亚组，阴性的靶向活检和额外的随机系统活检，这些活检仍然显示出具有临床意义的前列腺癌的高比率。在这项研究中，未能发现可疑病变的靶向方法和不准确的阳性MRI评分都导致了这些发现。4.尽管存在这些限制，Truong和他的同事们试图通过他们的研究进行调查的目标仍然是有用的-尽管活检阴性，前列腺癌的持续成像和实验室证据是一个常见而令人烦恼的问题。为了达到这一目的，创建预测性诺模图的理想环境将包括MRI分析和相应的活检结果，以及前列腺的整体标本
We read with interest the study by Truong et al, proposing a novel tool for predicting benign prostate pathology following a prior negative 12-core systematic biopsy. Of 285 included patients 46.3% of them had benign histological findings after targeted biopsy despite having abnormal magnetic resonance imaging (MRI). These were defined as a “false positive” MRI 1.This approach highlights the most challenging and controversial aspect of evaluating the targeted biopsy—defining the clear reference standard. As targeted biopsy is used in an interdisciplinary setting, all physicians involved (urologists, radiologists, pathologists, etc.) have a particular learning curve and must contend with uncertainty in the interpretation of their results 2. Gaziev et al. elucidated this in a recent study showing that radiologists, urologists as well as technologic differences may impact targeted biopsy results 3. In other words, using targeted biopsy results as the reference standard has clear limitations. If a prostate MRI revealed suspicious lesions and the following targeted biopsy yielded benign histologic findings, there are theoretically two possible sources of error: the PI-RADS score is falsely high or the targeted biopsy failed to accurately sample the lesion in question. To underscore this, Cash et al. analyzed a subgroup of 61 patients with suspicious MRI findings, a negative targeted biopsy and an additional random systematical biopsy, which still revealed a high rate of clinically significant prostate cancer. In this study, both the failure of the targeted approach to catch the suspicious lesion and the inaccurately positive MRI scores contributed to these findings 4. Despite these limitations, the objective Truong and his colleagues tried to investigate with their study is still useful—persistent imaging and laboratory evidence for prostate cancer despite negative biopsy is a common and vexing problem. The ideal setting to create a predictive nomogram to this end would involve MRI analysis and corresponding biopsy results together with whole-mount specimens of the prostate to
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？
DOI：
--
发表时间：
2007
期刊：
The Canadian journal of urology
影响因子：
--
作者：
K. Latchamsetty;L. Borden;C. Porter;M. Lacrampe;M. Vaughan;E. Lin;N. Conti;J. Wright;J. Corman
通讯作者：
J. Corman
影响因子：
4.5
作者：
Gaziev, Gabriele;Wadhwa, Karan;Kastner, Christof
通讯作者：
Kastner, Christof