Park Sung Yoon, Shin Su-Jin, Jung Dae Chul, Cho Nam Hoon, Choi Young Deuk, Rha Koon Ho, Hong Sung Joon, Oh Young Taik
Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Pathology, Hanyang University College of Medicine, Seoul, Republic of Korea.
Eur J Radiol. 2017 Jun;91:22-28. doi: 10.1016/j.ejrad.2017.03.009. Epub 2017 Mar 21.
To analyze whether Prostate Imaging Reporting and Data System (PI-RADSv2) scores are associated with a risk of normal-sized pelvic lymph node metastasis (PLNM) in prostate cancer (PCa).
A consecutive series of 221 patients who underwent magnetic resonance imaging and radical prostatectomy with pelvic lymph node dissection (PLND) for PCa were retrospectively analyzed under the approval of institutional review board in our institution. No patients had enlarged (≥0.8cm in short-axis diameter) lymph nodes. Clinical parameters [prostate-specific antigen (PSA), greatest percentage of biopsy core, and percentage of positive cores], and PI-RADSv2 score from two independent readers were analyzed with multivariate logistic regression and receiver operating-characteristic curve for PLNM. Diagnostic performance of PI-RADSv2 and Briganti nomogram was compared. Weighted kappa was investigated regarding PI-RADSv2 scoring.
Normal-sized PLNM was found in 9.5% (21/221) of patients. In multivariate analysis, PI-RADSv2 (reader 1, p=0.009; reader 2, p=0.026) and PSA (reader 1, p=0.008; reader 2, p=0.037) were predictive of normal-sized PLNM. Threshold of PI-RADSv2 was a score of 5, where PI-RADSv2 was associated with high sensitivity (reader 1, 95.2% [20/21]; reader 2, 90.5% [19/21]) and negative predictive value (reader 1, 99.2% [124/125]; reader 2, 98.6% [136/138]). However, diagnostic performance of PI-RADSv2 (AUC=0.786-0.788) was significantly lower than that of Briganti nomogram (AUC=0.890) for normal-sized PLNM (p<0.05). The inter-reader agreement was excellent for PI-RADSv2 of 5 or not (weighted kappa=0.804).
PI-RADSv2 scores may be associated with the risk of normal-sized PLNM in PCa.
分析前列腺影像报告和数据系统（PI-RADSv2）评分是否与前列腺癌（PCa）患者正常大小盆腔淋巴结转移（PLNM）风险相关。
在本机构机构审查委员会批准下，对连续221例行磁共振成像及前列腺癌根治术加盆腔淋巴结清扫术（PLND）的患者进行回顾性分析。所有患者均无肿大（短轴直径≥0.8cm）淋巴结。采用多因素逻辑回归分析及受试者工作特征曲线分析临床参数[前列腺特异性抗原（PSA）、穿刺活检核心组织最大百分比及阳性核心组织百分比]以及两位独立阅片者的PI-RADSv2评分与PLNM的关系。比较PI-RADSv2和Briganti列线图的诊断性能。对PI-RADSv2评分进行加权kappa分析。
9.5%（21/221）的患者存在正常大小的PLNM。多因素分析显示，PI-RADSv2（阅片者1，p = 0.009；阅片者2，p = 0.026）和PSA（阅片者1，p = 0.008；阅片者2，p = 0.037）可预测正常大小的PLNM。PI-RADSv2的阈值为5分，此时PI-RADSv2具有较高的敏感性（阅片者1，95.2%[20/21]；阅片者2，90.5%[19/21]）和阴性预测值（阅片者1，99.2%[124/125]；阅片者2，98.6%[136/138]）。然而，对于正常大小的PLNM，PI-RADSv2的诊断性能（AUC = 0.786 - 0.788）显著低于Briganti列线图（AUC = 0.890）（p < 0.05）。对于PI-RADSv2评分是否为5分，阅片者间一致性良好（加权kappa = 0.804）。
PI-RADSv2评分可能与PCa患者正常大小PLNM风险相关。
