INSERM, U1194, Institut de Recherche en Cancérologie de Montpellier (IRCM), Montpellier, France.
Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France.
Abdom Radiol (NY). 2017 Jul;42(7):1968-1974. doi: 10.1007/s00261-017-1086-7.
To assess the performance of the updated Prostate Imaging Reporting and Data System (PI-RADSv2) and the apparent diffusion coefficient (ADC) for predicting confirmatory biopsy results in patients considered for active surveillance of prostate cancer (PCA).
IRB-approved, retrospective study of 371 consecutive men with clinically low-risk PCA (initial biopsy Gleason score ≤6, prostate-specific antigen <10 ng/ml, clinical stage ≤T2a) who underwent 3T-prostate MRI before confirmatory biopsy. Two independent radiologists recorded the PI-RADSv2 scores and measured the corresponding ADC values in each patient. A composite score was generated to assess the performance of combining PI-RADSv2 + ADC.
PCA was upgraded on confirmatory biopsy in 107/371 (29%) patients. Inter-reader agreement was substantial (PI-RADSv2: k = 0.73; 95% CI [0.66-0.80]; ADC: r = 0.74; 95% CI [0.69-0.79]). Accuracies, sensitivities, specificities, positive predicted value and negative predicted value of PI-RADSv2 were 85, 89, 83, 68, 95 and 78, 82, 76, 58, 91% for ADC. PI-RADSv2 accuracy was significantly higher than that of ADC for predicting biopsy upgrade (p = 0.014). The combined PI-RADSv2 + ADC composite score did not perform better than PI-RADSv2 alone. Obviating biopsy in patients with PI-RADSv2 score ≤3 would have missed Gleason Score upgrade in 12/232 (5%) of patients.
PI-RADSv2 was superior to ADC measurements for predicting PCA upgrading on confirmatory biopsy.
评估更新后的前列腺影像报告和数据系统（PI-RADSv2）和表观扩散系数（ADC）在考虑对前列腺癌（PCA）进行主动监测的患者中预测确认性活检结果的性能。
对 371 例连续接受 3T 前列腺 MRI 检查的临床低危 PCA（初始活检 Gleason 评分≤6，前列腺特异性抗原<10ng/ml，临床分期≤T2a）患者进行回顾性研究，这些患者在确认性活检前均接受了检查。两位独立的放射科医生记录了 PI-RADSv2 评分，并测量了每位患者的相应 ADC 值。生成一个综合评分以评估结合 PI-RADSv2+ADC 的性能。
在 371 例患者中，有 107/371（29%）例患者在确认性活检中 PCA 升级。读者间的一致性较好（PI-RADSv2：k=0.73；95%CI[0.66-0.80]；ADC：r=0.74；95%CI[0.69-0.79]）。PI-RADSv2 的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为 85%、89%、83%、68%和 95%，ADC 的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为 78%、82%、76%、58%和 91%。PI-RADSv2 预测活检升级的准确性明显高于 ADC（p=0.014）。与单独使用 PI-RADSv2 相比，结合 PI-RADSv2+ADC 的综合评分并没有表现出更好的性能。在 PI-RADSv2 评分≤3 的患者中避免活检将导致 12/232（5%）例患者的 Gleason 评分升级被遗漏。
PI-RADSv2 优于 ADC 测量，可用于预测确认性活检中 PCA 的升级。
