Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands; Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Urol. 2013 Nov;190(5):1728-34. doi: 10.1016/j.juro.2013.05.021. Epub 2013 May 13.
We determined the positive and negative predictive values of multiparametric magnetic resonance imaging for extraprostatic extension at radical prostatectomy for different prostate cancer risk groups.
We evaluated a cohort of 183 patients who underwent 3 Tesla multiparametric magnetic resonance imaging, including T2-weighted, diffusion weighted magnetic resonance imaging and dynamic contrast enhanced sequences, with an endorectal coil before radical prostatectomy. Pathological stage at radical prostatectomy was used as standard reference for extraprostatic extension. The cohort was classified into low, intermediate and high risk groups according to the D'Amico criteria. We recorded prevalence of extraprostatic extension at radical prostatectomy and determined sensitivity, specificity, positive predictive value and negative predictive value of multiparametric magnetic resonance imaging for extraprostatic extension in each group. Univariate and multivariate analyses were performed to identify predictors of extraprostatic extension at radical prostatectomy.
The overall prevalence of extraprostatic extension at radical prostatectomy was 49.7% ranging from 24.7% to 77.1% between low and high risk categories. Overall staging accuracy of multiparametric magnetic resonance imaging for extraprostatic extension was 73.8%, with sensitivity, specificity, positive predictive value and negative predictive value of 58.2%, 89.1%, 84.1% and 68.3%, respectively. Positive predictive value of multiparametric magnetic resonance imaging for extraprostatic extension was best in the high risk cohort with 88.8%. Negative predictive value was highest in the low risk cohort with 87.7%. With an odds ratio of 10.3 multiparametric magnetic resonance imaging is by far the best preoperative predictor of extraprostatic extension at radical prostatectomy.
For adequate patient counseling, knowledge of predictive values of multiparametric magnetic resonance imaging for extraprostatic extension is of utmost importance. High negative predictive value, important for decisions on nerve sparing strategies at radical prostatectomy, is only reached in low risk subjects.
我们确定了多参数磁共振成像（mpMRI）在不同前列腺癌风险组根治性前列腺切除术中预测前列腺外延伸的阳性和阴性预测值。
我们评估了 183 例接受 3T 多参数磁共振成像（mpMRI）的患者，包括 T2 加权、扩散加权磁共振成像和动态对比增强序列，使用直肠内线圈。根治性前列腺切除术后的病理分期作为前列腺外延伸的标准参考。根据 D'Amico 标准，该队列被分为低、中、高危组。我们记录了根治性前列腺切除术后前列腺外延伸的发生率，并确定了每组中 mpMRI 对前列腺外延伸的敏感性、特异性、阳性预测值和阴性预测值。进行了单变量和多变量分析，以确定根治性前列腺切除术后前列腺外延伸的预测因素。
根治性前列腺切除术后前列腺外延伸的总发生率为 49.7%，低危和高危组之间的发生率从 24.7%到 77.1%不等。mpMRI 对前列腺外延伸的总体分期准确性为 73.8%，敏感性、特异性、阳性预测值和阴性预测值分别为 58.2%、89.1%、84.1%和 68.3%。mpMRI 对前列腺外延伸的阳性预测值在高危组中最佳，为 88.8%。在低危组中，阴性预测值最高，为 87.7%。mpMRI 的优势比为 10.3，是迄今为止预测根治性前列腺切除术后前列腺外延伸的最佳术前预测因素。
为了进行充分的患者咨询，了解 mpMRI 对前列腺外延伸的预测值至关重要。只有在低危患者中才能达到对根治性前列腺切除术神经保留策略决策很重要的高阴性预测值。
