Department of Urology, University of Rochester Medical Center, Rochester, New York.
Department of Radiology and Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York.
J Urol. 2017 Aug;198(2):316-321. doi: 10.1016/j.juro.2017.01.077. Epub 2017 Feb 3.
We determined whether Gleason pattern 4 architecture impacts tumor visibility on multiparametric magnetic resonance imaging and correlates with final histopathology.
A total of 83 tumor foci were identified in 22 radical prostatectomy specimens from patients with a prior negative biopsy who underwent magnetic resonance/ultrasound fusion biopsy followed by radical prostatectomy from January 2015 to July 2016. A genitourinary pathologist rereviewed tumor foci for Gleason architectural subtype. Each prostate imaging reporting and data system category 3 to 5 lesion on multiparametric magnetic resonance imaging was paired with its corresponding pathological tumor focus. Univariable and multivariable analyses were performed to determine predictors of tumor visibility.
Of the 83 tumor foci identified 26 (31%) were visible on multiparametric magnetic resonance imaging, 33 (40%) were Gleason score 3+3 and 50 (60%) were Gleason score 3+4 or greater. Among tumor foci containing Gleason pattern 4, increasing tumor size and noncribriform predominant architecture were the only independent predictors of tumor detection on multivariable analysis (p = 0.002 and p = 0.011, respectively). For tumor foci containing Gleason pattern 4, 0.5 cm or greater, multiparametric magnetic resonance imaging detected 10 of 13 (77%), 5 of 14 (36%) and 9 of 10 (90%) for poorly formed, cribriform and fused architecture, respectively (p = 0.01). The size threshold for the detection of cribriform tumors was higher than that of other architectural patterns. Furthermore, cribriform pattern was identified more frequently on systematic biopsy than on targeted biopsy.
Reduced visibility of cribriform pattern on multiparametric magnetic resonance imaging has significant ramifications for prostate cancer detection, surveillance and focal therapy.
我们旨在确定格里森 4 级结构是否会影响多参数磁共振成像中的肿瘤可视性，并与最终的组织病理学相关。
对 2015 年 1 月至 2016 年 7 月间行磁共振/超声融合活检后行根治性前列腺切除术的 22 例前列腺活检阴性患者的 83 个肿瘤灶进行了研究。泌尿生殖病理学家重新检查了肿瘤灶的格里森结构亚型。多参数磁共振成像上每一个前列腺影像报告和数据系统（PI-RADS）类别 3 到 5 级病变都与相应的病理肿瘤灶配对。进行了单变量和多变量分析以确定肿瘤可视性的预测因素。
在确定的 83 个肿瘤灶中，26 个（31%）在多参数磁共振成像上可见，33 个（40%）为 Gleason 评分 3+3，50 个（60%）为 Gleason 评分 3+4 或更高。在包含格里森 4 级结构的肿瘤灶中，肿瘤大小增加和非筛状为主的结构是多变量分析中肿瘤检测的唯一独立预测因素（p = 0.002 和 p = 0.011）。对于包含格里森 4 级结构的肿瘤灶，大小为 0.5cm 或更大，多参数磁共振成像检测到形态不规则、筛状和融合结构的肿瘤分别为 13 个中的 10 个（77%）、14 个中的 5 个（36%）和 10 个中的 9 个（90%）（p = 0.01）。筛状肿瘤的检测阈值大于其他结构模式。此外，在系统活检中比在靶向活检中更常发现筛状模式。
多参数磁共振成像中筛状模式的可视性降低对前列腺癌的检测、监测和局灶性治疗有重要影响。
