Raskolnikov Dima, George Arvin K, Rais-Bahrami Soroush, Turkbey Baris, Siddiqui M Minhaj, Shakir Nabeel A, Okoro Chinonyerem, Rothwax Jason T, Walton-Diaz Annerleim, Sankineni Sandeep, Su Daniel, Stamatakis Lambros, Merino Maria J, Choyke Peter L, Wood Bradford J, Pinto Peter A
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
J Urol. 2015 Jul;194(1):105-111. doi: 10.1016/j.juro.2015.01.072. Epub 2015 Jan 23.
Magnetic resonance imaging detects extracapsular extension by prostate cancer with excellent specificity but low sensitivity. This limits surgical planning, which could be modified to account for focal extracapsular extension with image directed guidance for wider excision. In this study we evaluate the performance of multiparametric magnetic resonance imaging in extracapsular extension detection and determine which preoperative variables predict extracapsular extension on final pathology when multiparametric magnetic resonance imaging predicts organ confined disease.
From May 2007 to March 2014, 169 patients underwent pre-biopsy multiparametric magnetic resonance imaging, magnetic resonance imaging/transrectal ultrasound fusion guided biopsy, extended sextant 12-core biopsy and radical prostatectomy at our institution. A subset of 116 men had multiparametric magnetic resonance imaging negative for extracapsular extension and were included in the final analysis.
The 116 men with multiparametric magnetic resonance imaging negative for extracapsular extension had a median age of 61 years (IQR 57-66) and a median prostate specific antigen of 5.51 ng/ml (IQR 3.91-9.07). The prevalence of extracapsular extension was 23.1% in the overall population. Sensitivity, specificity, and positive and negative predictive values of multiparametric magnetic resonance imaging for extracapsular extension were 48.7%, 73.9%, 35.9% and 82.8%, respectively. On multivariate regression analysis only patient age (p=0.002) and magnetic resonance imaging/transrectal ultrasound fusion guided biopsy Gleason score (p=0.032) were independent predictors of extracapsular extension on final radical prostatectomy pathology.
Because of the low sensitivity of multiparametric magnetic resonance imaging for extracapsular extension, further tools are necessary to stratify men at risk for occult extracapsular extension that would otherwise only become apparent on final pathology. Magnetic resonance imaging/transrectal ultrasound fusion guided biopsy Gleason score can help identify which men with prostate cancer have extracapsular extension that may not be detectable by imaging.
磁共振成像检测前列腺癌包膜外侵犯具有极高的特异性，但敏感性较低。这限制了手术规划，而手术规划可加以调整，以便在影像引导下对局限性包膜外侵犯进行更广泛切除。在本研究中，我们评估多参数磁共振成像在检测包膜外侵犯方面的性能，并确定当多参数磁共振成像预测为器官局限性疾病时，哪些术前变量可预测最终病理检查中的包膜外侵犯情况。
2007年5月至2014年3月，169例患者在我院接受了活检前多参数磁共振成像、磁共振成像/经直肠超声融合引导活检、扩大六分区12针活检及根治性前列腺切除术。116例男性患者多参数磁共振成像显示无包膜外侵犯，纳入最终分析。
116例多参数磁共振成像显示无包膜外侵犯的男性患者，中位年龄为61岁（四分位间距57 - 66岁），中位前列腺特异性抗原为5.51 ng/ml（四分位间距3.91 - 9.07 ng/ml）。总体人群中包膜外侵犯的发生率为23.1%。多参数磁共振成像检测包膜外侵犯的敏感性、特异性、阳性预测值和阴性预测值分别为48.7%、73.9%、35.9%和82.8%。多因素回归分析显示，仅患者年龄（p = 0.002）和磁共振成像/经直肠超声融合引导活检的Gleason评分（p = 0.032）是根治性前列腺切除术后最终病理检查中包膜外侵犯的独立预测因素。
由于多参数磁共振成像检测包膜外侵犯的敏感性较低，因此需要进一步的工具来对有隐匿性包膜外侵犯风险的男性进行分层，否则这些侵犯情况只有在最终病理检查时才会显现出来。磁共振成像/经直肠超声融合引导活检Gleason评分有助于识别哪些前列腺癌患者存在影像学无法检测到的包膜外侵犯。
