Departments of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Prostate Int. 2014 Dec;2(4):169-75. doi: 10.12954/PI.14057. Epub 2014 Dec 30.
Differentiating significant cancer from insignificant cancer is a major challenge in active surveillance (AS) for prostate cancer. We evaluated whether the apparent diffusion coefficient (ADC) grade from 3-T diffusion-weighted magnetic resonance imaging (DW-MRI) is useful to exclude men with unfavorable pathological features from men meeting current AS eligibility criteria.
Among patients who underwent radical prostatectomy, 117 potential AS candidates defined according to 2013 European Association of Urology guidelines who had undergone preoperative 3-T DW-MRI were included. A blinded uro-radiologist graded the level of suspicion from the ADC map using the Likert scale from 1 to 5. The rate of unfavorable pathological features was evaluated according to ADC grade. Unfavorable pathological features were defined as non-organ-confined disease or pathological Gleason score≥7 (4+3). The associations between unfavorable pathological features and clinical variables including ADC grade (>3 vs. ≤3) were evaluated using logistic regression analysis.
The rates of unfavorable pathological features were 0.0% (0/14), 2.9% (1/34), 5.4% (2/37), 25.0% (6/24), and 37.5% (3/8) from grades 1 to 5 (P=0.002). The predictive accuracy was as high as 0.804. The rates were significantly different between low (≤3, 3.5%) and high (>3, 28.1%, P<0.001) grades. The sensitivity, specificity, and positive and negative predictive values were 75.0%, 78.1%, 28.1%, and 96.5%. ADC grade (odds ratio [OR], 10.696; 95% confidence interval [CI], 2.675-42.773) was significantly associated with unfavorable pathological features, even after adjusting for other variables (OR, 11.274; 95% CI, 2.622-48.471).
ADC grade from 3-T DW-MRI is useful to predict men with unfavorable pathologic features from AS candidates.
在前列腺癌主动监测（AS）中，区分有意义的癌症和无意义的癌症是一项重大挑战。我们评估了 3-T 扩散加权磁共振成像（DW-MRI）的表观扩散系数（ADC）分级是否有助于将不符合当前 AS 入选标准的男性与符合条件的男性区分开来。
在接受根治性前列腺切除术的患者中，纳入了 117 名根据 2013 年欧洲泌尿外科学会指南定义的潜在 AS 候选者，他们均接受了术前 3-T DW-MRI 检查。一位盲法泌尿放射科医生使用 1 到 5 的李克特量表对 ADC 图的可疑程度进行分级。根据 ADC 分级评估不良病理特征的发生率。不良病理特征定义为非器官受限疾病或病理 Gleason 评分≥7（4+3）。使用逻辑回归分析评估不良病理特征与临床变量（包括 ADC 分级（>3 与≤3））之间的关系。
从 1 级到 5 级，不良病理特征的发生率分别为 0.0%（0/14）、2.9%（1/34）、5.4%（2/37）、25.0%（6/24）和 37.5%（3/8）（P=0.002）。预测准确率高达 0.804。低（≤3，3.5%）和高（>3，28.1%）分级之间的发生率差异有统计学意义（P<0.001）。灵敏度、特异性、阳性预测值和阴性预测值分别为 75.0%、78.1%、28.1%和 96.5%。ADC 分级（优势比[OR]，10.696；95%置信区间[CI]，2.675-42.773）与不良病理特征显著相关，即使在调整了其他变量后（OR，11.274；95%CI，2.622-48.471）。
3-T DW-MRI 的 ADC 分级有助于预测 AS 候选者中具有不良病理特征的男性。
