Liddell Heath, Jyoti Rajeev, Haxhimolla Hodo Z
Department of Urology, The Canberra Hospital, Garran, Australia.
Universal Medical Imaging, Calvary Hospital, Bruce, Australia.
Curr Urol. 2015 Jul;8(2):96-100. doi: 10.1159/000365697. Epub 2015 Jul 10.
To determine whether prostate image reporting and data system (PIRADS) 3 lesions as assessed by a 3T multiparametric magnetic resonance imaging (MRI) represent clinically significant prostate cancer.
A retrospective review was performed on a series of consecutive patients who underwent MRI guided biopsy of the prostate for clinical suspicion of prostate cancer between January 2013 and March 2014. Demographic, clinical, MRI and biopsy data were reviewed and compared. The same 3T MRI without the use of an endo-rectal coil was employed to assess each patient, obtaining high resolution T2 weighted images, diffusion weighted imaging and dynamic contrast enhancement. The MRI data was sent to Dynacad software for analysis. A single experienced radiologist reported all the studies from this series using a modified PIRADS scoring system. Subsequently, all the lesions marked PIRADS 3 or above were targeted with 18G core biopsy using DynaTrim in-gantry MRI guidance system. Needle position targeting the lesion was recorded prior to each biopsy. All core biopsy samples were sent to one of two pathology laboratories where they were processed and reported as per the International Society of Urological Pathology protocols.
One hundred and eighteen patients comprising a total of 215 lesions were reviewed. Amongst this cohort, 92 PIRADS 3 lesions were identified and biopsied. The mean age of patients in this cohort was 62.6 years. Median prostate specific antigen (PSA) was 6.5 ng/ml and median prostate size was 78.4 ml. Eightysix (93.5%) of biopsied PIRADS 3 lesions were benign and 6 (6.5%) lesions were found to be malignant. Of these 6 malignant lesions, 4 (66%) were Gleason score 6 (3 + 3) and 2 (33%) were Gleason score 7 (3 + 4). Of the 86 non-malignant lesions, 1 (1.2%) represented high-grade prostate intraepithelial neoplasia and 2 (2.4%) represented atypical small acinar proliferation. PIRADS 3 lesions within the peripheral zone were more likely to be associated with malignant disease compared with lesions identified within the transition zone (10.8 vs. 3.8%). Those with malignant disease had a higher median PSA (8.1 vs. 6.4 ng/ml) and higher median PSA density (0.12 vs. 0.08) than those without malignant disease. Those with benign pathology had a higher prevalence of inflammation (31.4 vs. 16.7%). As per Epstein's criteria, 4 (4.3%) of the biopsied lesions represented clinically significant disease.
We have demonstrated in our series, that prostate lesions characterized on a 3T multiparametric MRI examination of the prostate as PIRADS 3, according to the current prevalent scoring systems, are associated with a low likelihood of the presence of clinically significant prostate cancer.
确定经3T多参数磁共振成像（MRI）评估为前列腺影像报告和数据系统（PIRADS）3类的病变是否代表具有临床意义的前列腺癌。
对2013年1月至2014年3月期间因临床怀疑前列腺癌而接受MRI引导下前列腺穿刺活检的一系列连续患者进行回顾性研究。对人口统计学、临床、MRI和活检数据进行回顾和比较。使用同一台未使用直肠内线圈的3T MRI对每位患者进行评估，获取高分辨率T2加权图像、扩散加权成像和动态对比增强图像。将MRI数据发送至Dynacad软件进行分析。一位经验丰富的放射科医生使用改良的PIRADS评分系统对该系列中的所有研究进行报告。随后，使用DynaTrim机架内MRI引导系统对所有标记为PIRADS 3或更高的病变进行18G芯针穿刺活检。在每次活检前记录针对病变的针位置。所有芯针活检样本均送至两个病理实验室之一，按照国际泌尿病理学会的方案进行处理和报告。
共回顾了118例患者，共计215个病变。在该队列中，识别并活检了92个PIRADS 3类病变。该队列患者的平均年龄为62.6岁。前列腺特异性抗原（PSA）中位数为6.5 ng/ml，前列腺大小中位数为78.4 ml。86个（93.5%）活检的PIRADS 3类病变为良性，6个（6.5%）病变为恶性。在这6个恶性病变中，4个（66%）为Gleason评分6（3 + 3），2个（33%）为Gleason评分7（3 + 4）。在86个非恶性病变中，1个（1.2%）为高级别前列腺上皮内瘤变，2个（2.4%）为非典型小腺泡增生。与移行区内识别出的病变相比，外周区内的PIRADS 3类病变更可能与恶性疾病相关（10.8%对3.8%）。患有恶性疾病的患者PSA中位数（8.1对6.4 ng/ml）和PSA密度中位数（0.12对0.08）高于未患恶性疾病的患者。病理为良性的患者炎症患病率更高（31.
