Tsivian Matvey, Gupta Rajan T, Tsivian Efrat, Qi Peter, Mendez Melissa H, Abern Michael R, Tay Kae Jack, Polascik Thomas J
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.
Int J Urol. 2017 Feb;24(2):137-143. doi: 10.1111/iju.13251. Epub 2016 Nov 8.
To evaluate the diagnostic properties of multiparametric magnetic resonance imaging in the detection, localization and characterization of prostate cancer using three-dimensional transperineal template mapping biopsy histopathology as the comparator.
A retrospective analysis of patients undergoing prostate multiparametric magnetic resonance imaging followed by three-dimensional transperineal template mapping biopsy was carried out. For imaging and pathology data, the prostate was divided in octants with the urethra being the midline. The index test properties were calculated using the biopsy histopathology as the reference test with the following end-points: any cancer, any Gleason ≥7, any Gleason ≥7 or cancer length of ≥4 mm and any Gleason ≥7 or 6 mm in any given core. The latter two definitions correspond to 0.2 and 0.5 mL of cancer volume, respectively. Diagnostic properties including sensitivity, specificity, positive and negative predictive values were calculated.
A total of 50 patients were included in the study. A median of 55 (interquartile range 42-63) biopsy cores were obtained per patient. Of 400 prostate octants evaluated, 28.5% had prostate cancer on mapping biopsy, whereas 23% of octants were considered suspicious for cancer on imaging. Multiparametric magnetic resonance imaging negative predictive values for Gleason ≥7 and clinically significant cancers were 84-100%. Similarly, specificity ranged between 79% and 85%. Sensitivity and positive predictive value remained moderate for all the reference test definitions.
Multiparametric magnetic resonance imaging is a useful minimally-invasive tool for detection, localization and characterization of prostate cancer. This imaging modality has high negative predictive value and specificity, and therefore it could be used to reliably rule out clinically significant cancer, obviating the multicore mapping biopsy.
以三维经会阴模板定位活检组织病理学为对照，评估多参数磁共振成像在前列腺癌检测、定位及特征描述中的诊断性能。
对接受前列腺多参数磁共振成像检查并随后进行三维经会阴模板定位活检的患者进行回顾性分析。对于影像和病理数据，以尿道为中线将前列腺划分为八个象限。以活检组织病理学为参考标准，计算指标检测性能，终点如下：任何癌症、任何 Gleason 评分≥7、任何 Gleason 评分≥7 或癌长度≥4 mm 以及任何给定核心中任何 Gleason 评分≥7 或 6 mm。后两个定义分别对应 0.2 和 0.5 mL 的癌体积。计算包括敏感性、特异性、阳性和阴性预测值在内的诊断性能。
本研究共纳入 50 例患者。每位患者平均获得 55 个（四分位间距 42 - 63）活检核心。在评估的 400 个前列腺象限中，定位活检显示 28.5%有前列腺癌，而影像检查显示 23%的象限可疑为癌。Gleason 评分≥7 和临床显著癌症的多参数磁共振成像阴性预测值为 84% - 100%。同样，特异性在 79%至 85%之间。对于所有参考标准定义，敏感性和阳性预测值仍处于中等水平。
多参数磁共振成像是检测、定位及特征描述前列腺癌的一种有用的微创工具。这种成像方式具有较高的阴性预测值和特异性，因此可用于可靠地排除临床显著癌症，从而避免进行多核心定位活检。
