Multiparametric magnetic resonance imaging identifies significant apical prostate cancers
Multiparametric magnetic resonance imaging identifies significant apical prostate cancers
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DOI：
10.1111/bju.13987
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发表时间：
2018-02-01
影响因子：
4.5
通讯作者：
Lepor, Herbert
中科院分区：
文献类型：
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作者：
Kenigsberg, Alexander P.;Tamada, Tsutomu;Lepor, Herbert
目的确定多参数 (mp) 磁共振成像 (MRI) 是否可以识别显着的根尖部疾病，从而为有关保留膜状尿道的决策提供信息。 材料和方法 2012 年 1 月至 2016 年 6 月期间接受根治性前列腺切除术 (RP) 的男性，他们接受了 12 核经直肠超声引导下的系统活检 (SB)、术前 3-Tesla MRI 和肿瘤前列腺标本切片病灶映射是从单个外科医生的前瞻性纵向结果数据库中提取的。比较顶端 SB 和 mpMRI 病变结果预测前列腺尖部 (PA) 侵袭性肿瘤的能力，定义为前列腺癌分级组 >1。结果在 100 名符合资格标准的男性中，43 人 (43%) 在尖部远端 5 毫米处表现出侵袭性前列腺癌。研究发现，前列腺顶端三分之一处的 Likert 评分 >2 在检测顶端侵袭性癌症方面比在顶端 SB 上发现的任何癌症都更可靠。在多变量回归分析中，包括心尖部的 Likert 评分、年龄、前列腺特异性抗原 (PSA) 水平、前列腺大小和心尖活检中是否存在任何癌症，只有 Likert 评分 (P = 0.005) 和 PSA 水平 (P = 0.025) 是远端心尖侵袭性癌症的显着且独立的预测因子。 结论 研究结果表明，MRI 在识别远端 PA 内的侵袭性前列腺癌方面优于 SB，并且可能有助于规划 RP 期间根尖保存的范围。
ObjectiveTo determine if multiparametric (mp) magnetic resonance imaging (MRI) can identify significant apical disease, thereby informing decisions regarding preservation of the membranous urethra.Materials and MethodsMen undergoing radical prostatectomy (RP) between January 2012 and June 2016, who underwent a 12-core transrectal ultrasonography-guided systematic biopsy (SB), preoperative 3-Tesla MRI, and sectioning of the prostate specimen with tumour foci mapping, were extracted from a single surgeon's prospective longitudinal outcomes database. Apical SB and mpMRI lesion results were compared with regard to their ability to predict aggressive tumours in the prostatic apex (PA), defined as prostate cancer grade group >1.ResultsOf the 100 men who met the eligibility criteria, 43 (43%) exhibited aggressive prostate cancer in the distal 5 mm of the apex. A Likert score >2 in the apical one-third of the prostate was found to be more reliable than any cancer found on apical SB at detecting aggressive cancer in the apex. On multivariate regression analysis, which included Likert score in the apex, age, prostate-specific antigen (PSA) level, prostate size and presence of any cancer on apical biopsy, only Likert score (P = 0.005) and PSA level (P = 0.025) were significant and independent predictors of aggressive cancer in the distal apex.ConclusionThe results of the study showed that MRI was superior to SB at identifying aggressive prostate cancer within the distal PA and may be useful for planning the extent of apical preservation during RP.