弥散加权磁共振成像与扩展前列腺活检相结合可预测无显著癌的叶：在半根治性局灶治疗患者选择中的应用。

Combination of diffusion-weighted magnetic resonance imaging and extended prostate biopsy predicts lobes without significant cancer: application in patient selection for hemiablative focal therapy.

机构信息

Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.

出版信息

Eur Urol. 2014 Jan;65(1):186-92. doi: 10.1016/j.eururo.2012.10.010. Epub 2012 Oct 16.

DOI:10.1016/j.eururo.2012.10.010

PMID:23084330

Abstract

BACKGROUND

Significant cancer in contralateral sides of the prostate that was missed on prostate biopsy (PBx) is a concern in hemiablative focal therapy (FT) of prostate cancer (PCa). However, extended PBx, a common diagnostic procedure, has a limited predictive ability for lobes without significant cancer.

OBJECTIVE

To identify prostate lobes without significant cancer using extended PBx combined with diffusion-weighted imaging (DWI), which has the potential to provide pathophysiologic information on pretreatment assessment.

DESIGN, SETTING, AND PARTICIPANTS: We conducted a prebiopsy DWI study between 2007 and 2012 that included 270 prostate lobes in 135 patients who underwent radical prostatectomy (RP) for clinically localized PCa.

INTERVENTION

Participants underwent DWI and 14-core PBx; those with PBx-proven PCa and who were treated with RP were analyzed.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Imaging and pathology were assessed in each side. Based on RP pathology, lobes were classified into lobes with no cancer (LNC), lobes with indolent cancer (LIC), and lobes with significant cancer (LSC). Predictive performance of DWI, PBx, and their combination in identifying lobes without significant cancer was examined.

RESULTS AND LIMITATIONS

LNC, LIC, and LSC were identified in 23 (8.5%), 64 (23.7%), and 183 sides (67.8%), respectively. The negative predictive values (NPV) of DWI, PBx, and their combination were 22.1%, 27.8%, and 43.5%, respectively, for lobes with any cancer (ie, either LIC or LSC), and 68.4%, 72.2%, and 95.7%, respectively, for LSC. The NPV of PBx for LSC was improved by the addition of DWI findings (p=0.001), with no adverse influence on the positive predictive value. Limitations included a possible selection bias under which the decision to perform PBx might be affected by DWI findings.

CONCLUSIONS

The combination of DWI and extended PBx efficiently predicts lobes without significant cancer. This procedure is applicable to patient selection for hemiablative FT.

摘要

背景

在前列腺的对侧有显著的前列腺癌（PCa）而在前列腺活检（PBx）中被遗漏，这是前列腺癌半消融焦点治疗（FT）的一个关注点。然而，广泛的 PBx，一种常见的诊断程序，对没有显著癌症的叶具有有限的预测能力。

目的

使用扩展的 PBx 结合弥散加权成像（DWI）来识别没有显著癌症的前列腺叶，这有可能为预处理评估提供病理生理学信息。

设计、地点和参与者：我们在 2007 年至 2012 年期间进行了一项预活检 DWI 研究，该研究包括 135 名接受根治性前列腺切除术（RP）治疗临床局限性 PCa 的患者的 270 个前列腺叶。

干预

参与者接受 DWI 和 14 核 PBx；对 PBx 证实有 PCa 并接受 RP 治疗的患者进行分析。

测量和统计分析

对每一侧的影像学和病理学进行评估。根据 RP 病理学，将叶分为无癌叶（LNC）、惰性癌叶（LIC）和显著癌叶（LSC）。检查 DWI、PBx 及其组合在识别无显著癌叶中的预测性能。

结果和局限性

分别在 23（8.5%）、64（23.7%）和 183 个侧叶（67.8%）中发现了 LNC、LIC 和 LSC。DWI、PBx 及其组合对任何癌症（即 LIC 或 LSC）叶的阴性预测值（NPV）分别为 22.1%、27.8%和 43.5%，对 LSC 的 NPV 分别为 68.4%、72.2%和 95.7%。DWI 结果的加入改善了 PBx 对 LSC 的 NPV（p=0.001），对阳性预测值没有不利影响。局限性包括可能存在选择偏倚，在这种情况下，PBx 的决策可能会受到 DWI 结果的影响。