The value of endorectal MR imaging to predict positive biopsies in clinically intermediate-risk prostate cancer patients
The value of endorectal MR imaging to predict positive biopsies in clinically intermediate-risk prostate cancer patients
复制标题
DOI：
10.1007/s003300000616
复制
发表时间：
2001-01-01
影响因子：
5.9
通讯作者：
Delgado, E
中科院分区：
文献类型：
--
作者：
Vilanova, JC;Comet, J;Delgado, E
本研究的目的是评估直肠内磁共振成像在预测前列腺癌临床中度风险患者活检阳性结果方面的有效性。在1997年1月至1998年12月期间，我们对81名中等风险的前列腺癌患者进行了一项前瞻性直肠内磁共振成像研究。中度危险定义为：前列腺特异性抗原（PSA）水平在4 - 10 ng/ml之间或PSA水平在10-20 ng/ml范围内，但直肠指检（DRE）阴性或PSA水平逐渐升高（每年0.75 ng/ml(-1)）。经直肠核磁共振检查后进行经直肠六分仪活检，也对核磁共振成像检测到的可疑区域进行活检。通过计算受试者工作特征（ROC）曲线的面积指数，测量MR成像的准确度以及PSA水平和DRE的准确度。23例（28%）患者检出肿瘤，直肠内MRI的总体敏感性和特异性分别为70%和76%。总体患者组的ROC曲线下面积估计准确率为71%，PSA水平在10-20 ng/ml之间的患者组的准确率为84%，PSA水平在10-20 ng/ml和MR成像阳性的患者组的阳性活检率（PBR）为63%，MR检查阴性的患者为15%。PSA 4-10 ng/ml和MR阳性组PER为43%，MR阴性组PER为13%。我们可以避免63%的阴性活组织检查，同时遗漏30%的癌症患者。对于临床上处于前列腺癌中度风险的患者，直肠内磁共振成像并不能充分预测活检阳性。虽然我们不应该避免对直肠内磁共振成像结果为阴性的患者进行系统活检，因为它会遗漏大量的癌症，但选择PSA水平在10-20 ng/ml之间或临床活检不一致的患者可能会受益于直肠内磁共振成像。
The aim of this study was to assess the effectiveness of endorectal MR imaging in predicting the positive biopsy results in patients with clinically intermediate risk for prostate cancer. We performed a prospective endorectal MR imaging study with 81 patients at intermediate risk to detect prostate cancer between January 1997 and December 1998. Intermediate risk was defined as: prostatic specific antigen (PSA) levels between 4 and 10 ng/ml or PSA levels in the range of 10-20 ng/ml but negative digital rectal examination (DRE) or PSA levels progressively higher (0.75 ng/ml year(-1)). A transrectal sextant biopsy was performed after the endorectal MR exam, and also of the area of suspicion detected by MR imaging. The accuracies were measured, both singly for MR imaging and combined for PSA level and DRE, by calculating the area index of the receiver operating characteristics (ROC) curve. Cancer was detected in 23 patients (28 %), Overall sensitivity and specificity of endorectal MRI was 70 and 76 %, respectively. Accuracy was 71% estimated from the area under the ROC curve for the total patient group and 84 % for the group of patients with PSA level between 10-20 ng/ml, Positive biopsy rate (PBR) was 63 % for the group with PSA 10-20 ng/ml and a positive MR imaging, and 15 % with a negative MR exam. The PER was 43 % for the group with PSA 4-10 ng/ml and a positive MR study, and 13 % with a negative MR imaging examination. We would have avoided 63 % of negative biopsies, while missing 30 % of cancers for the total group of patients. Endorectal MR imaging was not a sufficient predictor of positive biopsies for patients clinically at intermediate risk for prostate cancer. Although we should not avoid performing systematic biopsies in patients with endorectal MR imaging negative results, as it will miss a significant number of cancers, selected patients with a PSA levels between 10-20 ng/ml or clinical-biopsy disagreement might benefit from endorectal MR imaging.