Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer.
Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer.
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DOI：
10.1016/j.juro.2012.07.024
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发表时间：
2012-11
期刊：
影响因子：
--
通讯作者：
Hricak H
中科院分区：
文献类型：
--
作者：
Vargas HA;Akin O;Afaq A;Goldman D;Zheng J;Moskowitz CS;Shukla-Dave A;Eastham J;Scardino P;Hricak H
接受前列腺癌(PCA)男性主动监测(AS)的一个障碍是在最初的活检时低估了癌症负担的风险。我们评估了直肠内磁共振成像(EMRI)在预测低危前列腺癌患者确认性活检升级中的价值。临床低风险前列腺癌患者388例，平均年龄60.6岁，年龄33~89岁，首次活检Gleason评分≤6，PSA和lt；10 ng/m L，临床分期≤T2a。三位放射科医生分别采用5分制对EMRI上的肿瘤可见度进行了回顾性评分(1-绝对无肿瘤-5-绝对有肿瘤)。用加权kappa统计量评估读者间的一致性。使用诊断性能和多变量Logistic回归方法评估MRI评分和确认性活检结果之间的相关性。在确认性活检中，79/388(20%)的患者Gleason评分提高。≤-2评分对确证活检升级有较高的阴性预测值(0.96~1.0)和特异性(0.95~1.0)。MRI评分为5分对确证活检的升级具有高度敏感性(0.87~0.98)。在多变量分析中，MRI评分较高的患者更有可能在确认性活检中升级(优势比=2.16-3.97)。经验较多的读者(kappa=0.41-0.61；曲线下面积[AUC]=0.76-0.79)的读者间一致性和诊断性能高于经验最少的读者(kappa=0.15-0.39；AUC=0.61-0.69)。MRI在预测低风险和极低风险(Gleason评分6分，3个阳性核心，所有核心50%受累)PCA方面的表现类似。将EMRI添加到临床低风险前列腺癌患者的初步临床评估中，有助于预测确诊活检的结果，并评估AS的资格。
A barrier to acceptance of active surveillance (AS) for men with prostate cancer (PCa) is the risk of underestimating the cancer burden upon initial biopsy. We assessed the value of endorectal magnetic resonance imaging (eMRI) in predicting upgrading on confirmatory biopsy in men with low-risk PCa. 388 consecutive men (mean age,60.6, range 33–89 years) with clinically low-risk PCa (initial biopsy Gleason score≤6, PSA<10 ng/mL, clinical stage≤T2a) underwent eMRI before confirmatory biopsy. Three radiologists independently, retrospectively scored tumor visibility on eMRI using a five-point scale (1-definitely no tumor—5-definitely tumor). Inter-reader agreement was assessed with weighted kappa statistics. Associations between MRI scores and confirmatory biopsy findings were evaluated using measures of diagnostic performance and multivariate logistic regression. On confirmatory biopsy, Gleason score was upgraded in 79/388 (20%) of patients. MRI scores ≤2 had high negative predictive value (0.96–1.0) and specificity (0.95–1.0) for upgrading on confirmatory biopsy. An MRI score of 5 was highly sensitive for upgrading on confirmatory biopsy (0.87–0.98). At multivariate analysis, patients with higher MRI scores were more likely to be upgraded on confirmatory biopsy (odds-ratios=2.16–3.97). Inter-reader agreement and diagnostic performance were higher for the more experienced readers (kappa=0.41–0.61; area under the curve [AUC]=0.76–0.79) than for the least experienced reader (kappa=0.15–0.39; AUC=0.61–0.69). MRI performed similarly in predicting low-risk and very low-risk (Gleason score 6, <3 positive cores, <50% involvement in all cores) PCa. Adding eMRI to the initial clinical evaluation in men with clinically low-risk PCa helps predict findings on confirmatory biopsy and assess eligibility for AS.
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影响因子：
19.7
作者：
Mullerad, M;Hricak, H;Scardino, PT
通讯作者：
Scardino, PT
影响因子：
120.7
作者：
EPSTEIN, JI;WALSH, PC;BRENDLER, CB
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作者：
LANDIS, JR;KOCH, GG
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