Defining the learning curve for multiparametric magnetic resonance imaging (MRI) of the prostate using MRI-transrectal ultrasonography (TRUS) fusion-guided transperineal prostate biopsies as a validation tool
Defining the learning curve for multiparametric magnetic resonance imaging (MRI) of the prostate using MRI-transrectal ultrasonography (TRUS) fusion-guided transperineal prostate biopsies as a validation tool
复制标题
DOI：
10.1111/bju.12892
复制
发表时间：
2016-01-01
影响因子：
4.5
通讯作者：
Kastner, Christof
中科院分区：
文献类型：
--
作者：
Gaziev, Gabriele;Wadhwa, Karan;Kastner, Christof
目的探讨多参数磁共振成像(MpMRI)在放射科医生学习过程中的准确性。方法根据Ginsburg研究小组和诊断准确度报告标准，收集340例接受mpMRI(T2加权和弥散加权MRI)和MTTP前列腺活检的患者的前瞻性资料，以确定多参数磁共振成像(MpMRI)在放射科医生学习曲线中的准确性。MRI数据由两名经验丰富的放射科医生报告，并按Likert量表进行评分。做活组织检查的是没有对核磁共振结果“视而不见”的泌尿科顾问医生，男性同时进行了针对性和系统性的部门活组织检查，并由专职的泌尿病理学家进行了审查。在研究中，队列被分成代表五个连续时间间隔的组。计算MRI阳性报告的敏感性和特异性、前列腺癌的MRI阳性诊断、Gleason评分显著分布和MRI阴性及假阴性前列腺癌的分布。结果A组患者mpMRI阳性率为91%，E组患者mpMRI阳性率为74%。前列腺癌mpMRI的发现率从A组的42%(27/)上升到E组的81%(42/52)(P<；0.001)。前列腺癌定位活检的发现率从A组的27%(17/)上升到E组的63%(33/52)(P<；0.001)。MRI对重大癌(GT；Gleason 3+3)的阴性预测值在E组为88.9%，而在A组为66.6%。结论随着时间的推移，MRI报告对前列腺癌的检测有所改善，提示该技术有一个学习曲线。随着对重大癌症的阴性预测值的提高，活检的决定应该与MRI结果一起基于患者/外科医生的因素和风险属性。
ObjectivesTo determine the accuracy of multiparametric magnetic resonance imaging (mpMRI) during the learning curve of radiologists using MRI targeted, transrectal ultrasonography (TRUS) guided transperineal fusion biopsy (MTTP) for validation.Patients and MethodsProspective data on 340 men who underwent mpMRI (T2weighted and diffusion-weighted MRI) followed by MTTP prostate biopsy, was collected according to Ginsburg Study Group and Standards for Reporting of Diagnostic Accuracy standards. MRI data were reported by two experienced radiologists and scored on a Likert scale. Biopsies were performed by consultant urologists not ` blinded' to the MRI result and men had both targeted and systematic sector biopsies, which were reviewed by a dedicated uropathologist. The cohorts were divided into groups representing five consecutive time intervals in the study. Sensitivity and specificity of positive MRI reports, prostate cancer detection by positive MRI, distribution of significant Gleason score and negative MRI with false negative for prostate cancer were calculated. Data were sequentially analysed and the learning curve was determined by comparing the first and last group.ResultsWe detected a positive mpMRI in 64 patients from Group A (91%) and 52 patients from Group E (74%). The prostate cancer detection rate on mpMRI increased from 42% (27/64) in Group A to 81% (42/52) in Group E (P < 0.001). The prostate cancer detection rate by targeted biopsy increased from 27% (17/64) in Group A to 63% (33/52) in Group E (P < 0.001). The negative predictive value of MRI for significant cancer (> Gleason 3+ 3) was 88.9% in Group E compared with 66.6% in Group A.ConclusionWe demonstrate an improvement in detection of prostate cancer for MRI reporting over time, suggesting a learning curve for the technique. With an improved negative predictive value for significant cancer, decision for biopsy should be based on patient/surgeon factors and risk attributes alongside the MRI findings.