Using spatial tracking with magnetic resonance imaging/ultrasound-guided biopsy to identify unilateral prostate cancer.
Using spatial tracking with magnetic resonance imaging/ultrasound-guided biopsy to identify unilateral prostate cancer.
复制标题
使用空间跟踪与磁共振成像/超声引导活检来识别单侧前列腺癌。
DOI：
10.1111/bju.14943
复制
发表时间：
2020
影响因子：
4.5
通讯作者：
Marks,LeonardS
中科院分区：
文献类型：
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作者：
Zhou,SteveR;Priester,AlanM;Jayadevan,Rajiv;Johnson,DavidC;Yang,JasonJ;Ballon,Jorge;Natarajan,Shyam;Marks,LeonardS
ObjectivesTo使用融合器械的空间跟踪创建可靠的单侧疾病预测指标，从而改善前列腺癌半腺消融术的患者选择。Patients and MethodsWe确定了2011年至2018年期间在一家机构接受磁共振成像（MRI）/超声引导活检和根治性前列腺切除术的患者。除了标准的临床特征外，我们还提取了与预测肿瘤单侧性的活检核心和MRI靶位置相关的定量特征。使用分类和回归树（CART）分析来创建用于识别癌症偏侧性的决策树（DT）。我们评估了模型确定的偏侧性与最终手术病理的一致性。ResultsA共173例患者被确定为活检坐标和手术病理可用。基于CART分析，除了活检和MRI证实的疾病单侧性外，还应进一步筛查患者在40 mL前列腺中线7 mm范围内检测到的癌症，这相当于任何大小前列腺半径的中心三分之一。该DT的曲线下面积为0.82。标准诊断和DT分别在73%和80%的患者中正确识别出疾病偏侧性（P= 0.13）。在通过标准诊断确定为单侧的患者中，47%未检测到对侧疾病或以其他方式被错误识别。这种错误率降低到17%（P= 0.01）与DT.ConclusionUsing融合设备的空间跟踪，DT是更可靠的识别前列腺癌的偏侧性相比，标准诊断。由于肿瘤中线延伸的风险，在前列腺中央三分之一半径内检测到癌症的患者是不良的半腺消融候选者。
ObjectivesTo create reliable predictive metrics of unilateral disease using spatial tracking from a fusion device, thereby improving patient selection for hemi‐gland ablation of prostate cancer.Patients and MethodsWe identified patients who received magnetic resonance imaging (MRI)/ultrasound‐guided biopsy and radical prostatectomy at a single institution between 2011 and 2018. In addition to standard clinical features, we extracted quantitative features related to biopsy core and MRI target locations predictive of tumour unilaterality. Classification and Regression Tree (CART) analysis was used to create a decision tree (DT) for identifying cancer laterality. We evaluated concordance of model‐determined laterality with final surgical pathology.ResultsA total of 173 patients were identified with biopsy coordinates and surgical pathology available. Based on CART analysis, in addition to biopsy‐ and MRI‐confirmed disease unilaterality, patients should be further screened for cancer detected within 7 mm of midline in a 40 mL prostate, which equates to the central third of any‐sized prostate by radius. The area under the curve for this DT was 0.82. Standard diagnostics and the DT correctly identified disease laterality in 73% and 80% of patients, respectively (P= 0.13). Of the patients identified as unilateral by standard diagnostics, 47% had undetected contralateral disease or were otherwise incorrectly identified. This error rate was reduced to 17% (P= 0.01) with the DT.ConclusionUsing spatial tracking from fusion devices, a DT was more reliable for identifying laterality of prostate cancer compared to standard diagnostics. Patients with cancer detected within the central third of the prostate by radius are poor hemi‐gland ablation candidates due to the risk of midline extension of tumour.