前列腺 MRI：与根治性前列腺切除术后组织病理学结果的观察者间一致性比较。

MRI of the prostate: interobserver agreement compared with histopathologic outcome after radical prostatectomy.

机构信息

Department of Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany.

出版信息

Eur J Radiol. 2012 Mar;81(3):456-60. doi: 10.1016/j.ejrad.2010.12.076. Epub 2011 Feb 26.

DOI:10.1016/j.ejrad.2010.12.076

PMID:21354732

Abstract

BACKGROUND

The purpose of this study was to evaluate interobserver agreement of prostatic MRI in assessing the performance of staging prostate carcinoma in comparison with histopathologic step section prostate specimens.

METHODS

We retrospectively evaluated 46 patients who underwent prostatic MRI examination at 1.5 T MRI and "subsequently" radical prostatectomy. All MR-images were reevaluated by two different experienced radiologists (15 and 1.5 years of experience) with special focus on T2/T3 differentiation. Both radiologists were not aware of the patient's clinical data, except that the patient had prostate cancer. These findings were compared with histopathologic whole mount step section prostate specimens, which served as the "gold standard". Fourfold tables were created to calculate sensitivity, specificity, positive and negative predictive values and efficiency for T2/T3 differentiation. Cohen's kappa was calculated to measure inter-rater agreement.

RESULTS

Twenty-eight patients were diagnosed with organ defined cancer (T2), 18 patients were staged with extracapsular extension (T3), and thereof 7 patients were staged with seminal vesicle invasion (T3b) by the pathologists. The experienced reader reached a sensitivity of 77.78% (95%-CI 52.36%; 93.59%) and specificity of 92.86% (95%-CI 76.50%; 99.12%) for T2/T3 differentiation, the less experienced reader however achieved a sensitivity of 33.33% (95%-CI 13.34%; 59.01%) and specificity of 71.43% (95%-CI 51.33%; 86.78%). The Cohen's kappa for inter-rater reliability for differentiation between T2 and T3 stage was κ=0.0129.

CONCLUSIONS

Evaluation of prostatic MR imaging requires lengthy experience for accurate interpretation and staging. While a highly experienced reader can achieve good correlation with histopathology even without utilization of functional MR imaging, a less experienced reader with theoretical knowledge falls short of expectation.

摘要

背景

本研究旨在评估前列腺 MRI 检查在评估前列腺癌分期方面的观察者间一致性，并与前列腺组织学切片标本进行比较。

方法

我们回顾性评估了 46 例在 1.5T MRI 上进行前列腺 MRI 检查并随后接受根治性前列腺切除术的患者。两位经验丰富的放射科医生（分别有 15 年和 1.5 年的经验）对所有 MRI 图像进行了重新评估，重点关注 T2/T3 分化。两位放射科医生均不知道患者的临床数据，只知道患者患有前列腺癌。这些发现与作为“金标准”的前列腺组织学全切片标本进行了比较。创建四格表以计算 T2/T3 分化的敏感性、特异性、阳性和阴性预测值和效率。计算 Cohen's kappa 以衡量观察者间的一致性。

结果

28 例患者被诊断为器官局限性癌症（T2），18 例患者被分期为包膜外扩展（T3），其中 7 例患者被病理学家分期为精囊侵犯（T3b）。有经验的读者达到了 77.78%（95%CI 52.36%；93.59%）的 T2/T3 分化敏感性和 92.86%（95%CI 76.50%；99.12%）的特异性，而经验较少的读者则达到了 33.33%（95%CI 13.34%；59.01%）的敏感性和 71.43%（95%CI 51.33%；86.78%）的特异性。T2 和 T3 分期的观察者间可靠性的 Cohen's kappa 值为 κ=0.0129。