Rais-Bahrami Soroush, Türkbey Barış, Rastinehad Ardeshir R, Walton-Diaz Annerleim, Hoang Anthony N, Siddiqui M Minhaj, Stamatakis Lambros, Truong Hong, Nix Jeffrey W, Vourganti Srinivas, Grant Kinzya B, Merino Maria J, Choyke Peter L, Pinto Peter A
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Diagn Interv Radiol. 2014 Jul-Aug;20(4):293-8. doi: 10.5152/dir.2014.13319.
We aimed to determine the natural history of small index lesions identified on multiparametric-magnetic resonance imaging (MP-MRI) of the prostate by evaluating lesion-specific pathology and growth on serial MP-MRI.
We performed a retrospective review of 153 patients who underwent a minimum of two MP-MRI sessions, on an institutional review board-approved protocol. Index lesion is defined as the lesion(s) with the highest cancer suspicion score based on initial MP-MRI of a patient, irrespective of size. Two study cohorts were identified: (1) patients with no index lesion or index lesion(s) ≤7 mm and (2) a subset with no index lesion or index lesion(s) ≤5 mm. Pathological analysis of the index lesions was performed following magnetic resonance/ultrasound fusion-guided biopsy. Growth rate of the lesions was calculated based on MP-MRI follow-up.
Patients with small index lesions measuring ≤7 mm (n=42) or a subset with lesions ≤5 mm (n=20) demonstrated either benign findings (86.2% and 87.5%, respectively) or low grade Gleason 6 prostate cancer (13.8% and 12.5%, respectively) on lesion-specific targeted biopsies. These lesions demonstrated no significant change in size (P = 0.93 and P = 0.36) over a mean imaging period of 2.31±1.56 years and 2.40±1.77 years for ≤7 mm and ≤5 mm index lesion thresholds, respectively. These findings held true on subset analyses of patients who had a minimum of two-year interval follow-up with MP-MRI.
Small index lesions of the prostate are pathologically benign lesions or occasionally low-grade cancers. Slow growth rate of these small index lesions on serial MP-MRI suggests a surveillance interval of at least two years without significant change.
我们旨在通过评估病变特异性病理及在系列多参数磁共振成像（MP-MRI）上的生长情况，来确定前列腺MP-MRI检查发现的小目标病变的自然病程。
我们依据机构审查委员会批准的方案，对153例至少接受过两次MP-MRI检查的患者进行了回顾性研究。目标病变定义为基于患者初次MP-MRI检查，癌症怀疑评分最高的病变，无论其大小。确定了两个研究队列：（1）无目标病变或目标病变≤7mm的患者，以及（2）无目标病变或目标病变≤5mm的亚组。在磁共振/超声融合引导下活检后，对目标病变进行病理分析。根据MP-MRI随访结果计算病变的生长率。
目标病变≤7mm的患者（n = 42）或病变≤5mm的亚组（n = 20）在病变特异性靶向活检中显示为良性结果（分别为86.2%和87.5%）或低级别Gleason 6前列腺癌（分别为13.8%和12.5%）。对于≤7mm和≤5mm的目标病变阈值，在平均2.31±1.56年和2.40±1.77年的成像期内，这些病变大小无显著变化（P = 0.93和P = 0.36）。在对至少进行了两年MP-MRI随访的患者亚组分析中，这些结果依然成立。
前列腺小目标病变在病理上为良性病变，偶尔为低级别癌症。这些小目标病变在系列MP-MRI上生长缓慢，提示至少两年的监测间隔内无显著变化。
