前列腺影像和数据报告系统（PI-RADS）v. 2评估类别4和5与根治性前列腺切除术后组织病理学结果相比的预后价值。
Prognostic value of Prostate Imaging and Data Reporting System (PI-RADS) v. 2 assessment categories 4 and 5 compared to histopathological outcomes after radical prostatectomy.
作者信息
Lim Christopher S, McInnes Matthew D F, Lim Robert S, Breau Rodney H, Flood Trevor A, Krishna Satheesh, Morash Christopher, Shabana Wael M, Schieda Nicola
机构信息
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada.
Ottawa Hospital, University of Ottawa, Division of Urology, Department of Surgery, General Campus, Ottawa, Ontario, Canada.
出版信息
J Magn Reson Imaging. 2017 Jul;46(1):257-266. doi: 10.1002/jmri.25539. Epub 2016 Nov 3.
PURPOSE
To assess Prostate Imaging and Data Reporting System (PI-RADS) v. 2 score 4/5 lesions compared to Gleason score (GS) and stage after radical prostatectomy (RP) and to validate the proposed 15-mm size threshold that differentiates category 4 versus 5 lesions.
MATERIALS AND METHODS
With Institutional Review Board (IRB) approval, 140 men underwent 3T magnetic resonance imaging (MRI) and RP between 2012-2015. Two blinded radiologists: 1) assigned PI-RADS v. 2 scores, 2) measured tumor size on axial T -weighted-MRI, and 3) assessed for extraprostatic extension (EPE). Interobserver agreement was calculated and consensus diagnoses achieved through reference standard (MRI-RP maps). PI-RADS v. 2 scores and tumor size were compared to GS and stage using chi-square, analysis of variance (ANOVA), and receiver operating characteristic (ROC) curve analysis.
RESULTS
In all, 80.7% (113/140) of tumors were category 4 (n = 45) or 5 (n = 68) lesions (κ = 0.45). Overall tumor size was 18.2 ± 7.7 mm and category 5 lesions were larger (22.6 ± 6.8 versus 11.5 ± 1.9 mm, P < 0.001). High-risk (GS ≥8) tumors were larger than low- and intermediate-risk tumors (P = 0.016) and were more frequently, but not significantly so, category 5 lesions (78.9% [15/19] vs. 22.1% [4/10], P = 0.18). 67.3% (76/113) of patients had EPE. Category 5 lesions were strongly associated with EPE (P < 0.0001). Area under the ROC curve for diagnosis of EPE by size was 0.74 (confidence interval 0.64-0.83), with size ≥15 mm yielding a sensitivity/specificity of 72.4/64.9%. Size improved sensitivity for diagnosis of EPE compared to subjective assessment (sensitivity/specificity ranging from 46.1-48.7%/70.3-86.5%, κ = 0.29) (P = 0.028).
CONCLUSION
PI-RADS v. 2 category 5 lesions are associated with higher Gleason scores and EPE. A 15-mm size threshold is reasonably accurate for diagnosis of EPE with increased sensitivity compared to subjective assessment.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:257-266.
目的
评估前列腺影像报告和数据系统（PI-RADS）v. 2版4/5分病变与根治性前列腺切除术（RP）后的 Gleason评分（GS）及分期的相关性，并验证所提出的区分4类与5类病变的15毫米大小阈值。
材料与方法
经机构审查委员会（IRB）批准，2012年至2015年间，140名男性接受了3T磁共振成像（MRI）检查及RP手术。两名盲法放射科医生：1）确定PI-RADS v. 2版评分，2）在轴位T加权MRI上测量肿瘤大小，3）评估是否存在前列腺外侵犯（EPE）。计算观察者间一致性，并通过参考标准（MRI-RP图谱）达成共识诊断。使用卡方检验、方差分析（ANOVA）和受试者操作特征（ROC）曲线分析，将PI-RADS v. 2版评分及肿瘤大小与GS和分期进行比较。
结果
总体而言，80.7%（113/140）的肿瘤为4类（n = 45）或5类（n = 68）病变（κ = 0.45）。肿瘤总体大小为18.2±7.7毫米，5类病变更大（22.6±6.8毫米对11.5±1.9毫米，P < 0.001）。高危（GS≥8）肿瘤比低危和中危肿瘤更大（P = 0.016），且更频繁地为5类病变，但差异无统计学意义（78.9% [15/19]对22.1% [4/10]，P = 0.18）。67.3%（76/113）的患者存在EPE。5类病变与EPE密切相关（P < 0.0001）。通过大小诊断EPE的ROC曲线下面积为0.74（置信区间0.64 - 0.83），大小≥15毫米时的敏感性/特异性为7, 在诊断EPE时，与主观评估相比，大小提高了敏感性（敏感性/特异性范围为46.1 - 48.7%/70.3 - 86.5%，κ = 0.29）（P = 0.028）。
结论
PI-RADS v. 2版5类病变与更高的Gleason评分及EPE相关。15毫米的大小阈值在诊断EPE时相当准确，与主观评估相比敏感性增加。
证据水平
3 技术效能：2级 J.MAGN.RESON.IMAGING 2017;46:257 - 266。
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