Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI-RADS) scoring in a transperineal prostate biopsy setting
Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI-RADS) scoring in a transperineal prostate biopsy setting
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DOI：
10.1111/bju.12862
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发表时间：
2015-05-01
影响因子：
4.5
通讯作者：
Acher, Peter L.
中科院分区：
文献类型：
--
作者：
Grey, Alistair D. R.;Chana, Manik S.;Acher, Peter L.
ObjectivesTo determine sensitivity and specificity of multiparametric magnetic resonance imaging（mpMRI）for significant prostate cancer with transperineal sector biopsy（TPSB）as the reference standard.Patients and MethodsThe study included continuous patients who presented for TPSB between July 2012 and November 2013 after mpMRI（T2-and diffusion-weighted images，1.5 Tesla scanner，8-channel body coil）.泌尿放射科专家对临床细节不知情，在Likert类型量表上分配定性前列腺成像报告和数据系统（PI-RADS）评分，表示显著前列腺癌的可能性如下：1，极不可能; 3，不确定; 5，极可能。TPSB对每例患者采样24-40个核心（取决于前列腺大小）。显著的前列腺癌被定义为存在的Gleason模式4或癌核心长度>= 6 mm.ResultsA共201例患者被纳入分析。适应症为：既往经直肠活检阴性，持续怀疑前列腺癌（n = 103）;初次活检（n = 83）;主动监测（n = 15）。患者的平均（+/- SD）年龄、前列腺特异性抗原和前列腺体积分别为65（+/- 7）岁、12.8（+/- 12.4）ng/mL和62（+/- 36）mL。总体而言，分别有124例（62%）、20例（10%）和57例（28%）患者的活检结果为良性、无临床意义和有临床意义。PI-RADS评分为1或2的88名男性中有2名患有显著的前列腺癌，在此阈值下，灵敏度为97%（95%置信区间[CI] 87-99），特异性为60%（95% CI 51-68）。受试者-操作者曲线分析得出曲线下面积为0.89（95% CI 0.82-0.92）。PI-RADS评分≥ 2对有临床意义的前列腺癌的阴性预测值为97.7%。结论我们发现PI-RADS评分可以很好地作为活检结果的预测因子，可以用于前列腺活检的决策过程。
ObjectivesTo determine the sensitivity and specificity of multiparametric magnetic resonance imaging (mpMRI) for significant prostate cancer with transperineal sector biopsy (TPSB) as the reference standard.Patients and MethodsThe study included consecutive patients who presented for TPSB between July 2012 and November 2013 after mpMRI (T2-and diffusion-weighted images, 1.5 Tesla scanner, 8-channel body coil). A specialist uro-radiologist, blinded to clinical details, assigned qualitative prostate imaging reporting and data system (PI-RADS) scores on a Likert-type scale, denoting the likelihood of significant prostate cancer as follows: 1, highly unlikely; 3, equivocal; and 5, highly likely. TPSBs sampled 24-40 cores (depending on prostate size) per patient. Significant prostate cancer was defined as the presence of Gleason pattern 4 or cancer core length >= 6 mm.ResultsA total of 201 patients were included in the analysis. Indications were: a previous negative transrectal biopsy with continued suspicion of prostate cancer (n = 103); primary biopsy (n = 83); and active surveillance (n = 15). Patients' mean (+/- SD) age, prostate-specific antigen and prostate volumes were 65 (+/- 7) years, 12.8 (+/- 12.4) ng/mL and 62 (+/- 36) mL, respectively. Overall, biopsies were benign, clinically insignificant and clinically significant in 124 (62%), 20 (10%) and 57 (28%) patients, respectively. Two of 88 men with a PI-RADS score of 1 or 2 had significant prostate cancer, giving a sensitivity of 97% (95% confidence interval [CI] 87-99) and a specificity of 60% (95% CI 51-68) at this threshold. Receiver-operator curve analysis gave an area under the curve of 0.89 (95% CI 0.82-0.92). The negative predictive value of a PI-RADS score of = 2 for clinically significant prostate cancer was 97.7%ConclusionWe found that PI-RADS scoring performs well as a predictor for biopsy outcome and could be used in the decision-making process for prostate biopsy.