Siddiqui M Minhaj, Truong Hong, Rais-Bahrami Soroush, Stamatakis Lambros, Logan Jennifer, Walton-Diaz Annerleim, Turkbey Baris, Choyke Peter L, Wood Bradford J, Simon Richard M, Pinto Peter A
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
J Urol. 2015 Jun;193(6):1943-1949. doi: 10.1016/j.juro.2015.01.088. Epub 2015 Jan 26.
Multiparametric magnetic resonance imaging may be beneficial in the search for rational ways to decrease prostate cancer intervention in patients on active surveillance. We applied a previously generated nomogram based on multiparametric magnetic resonance imaging to predict active surveillance eligibility based on repeat biopsy outcomes.
We reviewed the records of 85 patients who met active surveillance criteria at study entry based on initial biopsy and who then underwent 3.0 Tesla multiparametric magnetic resonance imaging with subsequent magnetic resonance imaging/ultrasound fusion guided prostate biopsy between 2007 and 2012. We assessed the accuracy of a previously published nomogram in patients on active surveillance before confirmatory biopsy. For each cutoff we determined the number of biopsies avoided (ie reliance on magnetic resonance imaging alone without rebiopsy) over the full range of nomogram cutoffs.
We assessed the performance of the multiparametric magnetic resonance imaging active surveillance nomogram based on a decision to perform biopsy at various nomogram generated probabilities. Based on cutoff probabilities of 19% to 32% on the nomogram the number of patients who could be spared repeat biopsy was 27% to 68% of the active surveillance cohort. The sensitivity of the test in this interval was 97% to 71% and negative predictive value was 91% to 81%.
Multiparametric magnetic resonance imaging based nomograms may reasonably decrease the number of repeat biopsies in patients on active surveillance by as much as 68%. Analysis over the full range of nomogram generated probabilities allows patient and caregiver preference based decision making on the risk assumed for the benefit of fewer repeat biopsies.
多参数磁共振成像可能有助于寻找合理的方法，以减少接受主动监测的前列腺癌患者的干预措施。我们应用了先前基于多参数磁共振成像生成的列线图，根据重复活检结果预测主动监测的适宜性。
我们回顾了85例患者的记录，这些患者在研究开始时根据初次活检符合主动监测标准，然后在2007年至2012年间接受了3.0特斯拉多参数磁共振成像检查，并随后进行了磁共振成像/超声融合引导下的前列腺活检。我们评估了先前发表的列线图在确诊性活检前接受主动监测的患者中的准确性。对于每个临界值，我们在列线图临界值的整个范围内确定避免活检的数量（即仅依靠磁共振成像而不进行再次活检）。
我们根据在列线图生成的各种概率下进行活检的决定，评估了多参数磁共振成像主动监测列线图的性能。根据列线图上19%至32%的临界概率，可避免重复活检的患者数量为主动监测队列的27%至68%。该区间内检测的敏感性为97%至71%，阴性预测值为91%至81%。
基于多参数磁共振成像的列线图可合理地将接受主动监测患者的重复活检数量减少多达68%。对列线图生成的所有概率进行分析，有助于患者和护理人员根据对较少重复活检益处所承担风险的偏好做出决策。
