PI-RADSv2 评分和定量表观扩散系数在考虑主动监测前列腺癌的患者中预测确认性前列腺活检结果的性能。
The performance of PI-RADSv2 and quantitative apparent diffusion coefficient for predicting confirmatory prostate biopsy findings in patients considered for active surveillance of prostate cancer.
机构信息
INSERM, U1194, Institut de Recherche en Cancérologie de Montpellier (IRCM), Montpellier, France.
Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France.
出版信息
Abdom Radiol (NY). 2017 Jul;42(7):1968-1974. doi: 10.1007/s00261-017-1086-7.
PURPOSE
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).
METHODS
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.
RESULTS
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.
CONCLUSION
PI-RADSv2 was superior to ADC measurements for predicting PCA upgrading on confirmatory biopsy.
目的
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。
方法
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。
结果
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。
结论
PI-RADSv2 优于 ADC 测量，可用于预测确认性活检中 PCA 的升级。
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