Risk Stratification Among Men With Prostate Imaging Reporting and Data System Version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary?
Risk Stratification Among Men With Prostate Imaging Reporting and Data System Version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary?
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DOI：
10.2214/ajr.17.18008
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发表时间：
2017-12-01
影响因子：
5
通讯作者：
Marks, Leonard S.
中科院分区：
文献类型：
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作者：
Felker, Ely R.;Raman, Steven S.;Marks, Leonard S.
OBJECTIVE.我们研究的目的是确定前列腺成像报告和数据系统第2版（PI-RADSv 2）3类移行区（TZ）病变的男性中具有临床意义的前列腺癌（PCA）（Gleason评分>= 3 + 4）的临床和MRI特征。从2014年到2016年，865名男性接受了前列腺MRI和MRI/超声（US）融合活检（FB）。确定了90名未接受过FB治疗的男性患者的一个子集，其中有96处PI-RADSv 2 3类TZ病变。使用体线圈在3 T下对患者进行成像。由经验丰富的放射科医生将图像分配为PI-RADSv 2类别。利用临床数据和影像学特征，我们进行了单变量和多变量分析，以确定具有临床意义的PCA的预测因子。患者平均年龄为66岁，平均前列腺特异性抗原密度（PSAD）为0.13 ng/mL（2）。在96个病变中的34个（35%）中检测到PCA，其中14个（15%）具有临床意义的PCA。在单变量分析中，DWI评分、前列腺体积和PSAD是临床显著PCA的显著预测因子（p < 0.05），表观扩散系数（ADC）和前列腺特异性抗原值（p < 0.10）具有显著意义。在多变量分析中，PSAD和病变ADC是最重要的协变量。PSAD ≥ 0.15 ng/mL（2）且ADC值小于1000 mm（2）/s的组合产生临床显著PCA的AUC为0.91（p < 0.001）。如果FB仅限于这些标准，90名男性中只有10名接受了活检，导致60%的患者诊断为临床显著的PCA，8名男性（9%）被误诊（假阴性）。患有PI-RADSv 2 3类TZ病变且具有临床意义的PCA的男性中，FB的发生率为15%，但在PSAD为0.15 ng/mL（2）或更大且病变ADC值小于1000 m（2）/s的男性中，FB的发生率显着提高至60%（AUC > 0.9）。
OBJECTIVE. The objective of our study was to determine the clinical and MRI characteristics of clinically significant prostate cancer (PCA) (Gleason score >= 3 + 4) in men with Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) category 3 transition zone (TZ) lesions.MATERIALS AND METHODS. From 2014 to 2016, 865 men underwent prostate MRI and MRI/ultrasound (US) fusion biopsy (FB). A subset of 90 FB-naive men with 96 PI-RADSv2 category 3 TZ lesions was identified. Patients were imaged at 3 T using a body coil. Images were assigned a PI-RADSv2 category by an experienced radiologist. Using clinical data and imaging features, we performed univariate and multivariate analyses to identify predictors of clinically significant PCA.RESULTS. The mean patient age was 66 years, and the mean prostate-specific antigen density (PSAD) was 0.13 ng/mL(2). PCA was detected in 34 of 96 (35%) lesions, 14 of which (15%) harbored clinically significant PCA. In univariate analysis, DWI score, prostate volume, and PSAD were significant predictors (p < 0.05) of clinically significant PCA with a suggested significance for apparent diffusion coefficient (ADC) and prostate-specific antigen value (p < 0.10). On multivariate analysis, PSAD and lesion ADC were the most important covariates. The combination of both PSAD of 0.15 ng/mL(2) or greater and an ADC value of less than 1000 mm(2)/s yielded an AUC of 0.91 for clinically significant PCA (p < 0.001). If FB had been restricted to these criteria, only 10 of 90 men would have undergone biopsy, resulting in diagnosis of clinically significant PCA in 60% with eight men (9%) misdiagnosed (false-negative).CONCLUSION. The yield of FB in men with PI-RADSv2 category 3 TZ lesions for clinically significant PCA is 15% but significantly improves to 60% (AUC > 0.9) among men with PSAD of 0.15 ng/mL(2) or greater and lesion ADC value of less than 1000 m(2)/s.