Petersen Lars J, Mortensen Jesper C, Bertelsen Henrik, Zacho Helle D
Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
BMC Med Imaging. 2017 Jul 10;17(1):40. doi: 10.1186/s12880-017-0211-y.
The purpose of this study was to compare the agreement of the bone scan index (BSI) using EXINI Bone versus experts' readings in the initial staging for bone metastasis in prostate cancer. In addition, the diagnostic outcome was assessed in a large subset of patients where a true reference for metastases could be determined based on clinical and biochemical follow-up and/or supplementary imaging.
A total of 342 patients had a bone scintigraphy as part of routine staging for prostate cancer. Supplementary imaging was obtained at the discretion of the referring urologist. After full recruitment, the BSI and the number of malignant lesions were calculated using EXINI Bone, and three imaging experts independently classified bone status by a dichotomous outcome (M1 for bone metastasis, M0 for no bone metastasis). A true reference was available in a subset of the patients based on post-operative prostate-specific antigen responses after radical prostatectomy and/or supplementary imaging.
Software analysis with a BSI > 0 as the cut-off for metastasis showed excellent agreement with expert classification for M1 disease (96% of the patients) but modest agreement for M0 disease (38%). With a BSI > 1, the agreement was 58% for M1 and 98% for M0. Software analyses based on individual European Association of Urology risk classification did not improve the diagnostic performance. Among patients with a true reference, the software showed metastasis in 64% of the M0 patients but correctly classified metastases in all M1 patients. The sensitivity was 100%, the specificity was 36%, the positive predictive value was 12.6% and the negative predictive value was 100% with a BSI >0 compared with 66.7%, 97.8%, 72.7%, and 97.0% with a BSI > 1.
The diagnostic value of using EXINI Bone for the BSI in the staging of newly diagnosed prostate cancer is limited.
本研究的目的是比较使用EXINI Bone软件得出的骨扫描指数（BSI）与专家在前列腺癌骨转移初始分期中的读片结果之间的一致性。此外，在很大一部分患者中评估了诊断结果，这些患者的转移情况可根据临床和生化随访及/或补充影像学检查来确定真实参考标准。
共有342例患者进行了骨闪烁显像，作为前列腺癌常规分期的一部分。补充影像学检查由转诊的泌尿科医生酌情进行。在全部患者入组后，使用EXINI Bone软件计算BSI和恶性病变数量，三位影像专家通过二分法结果（骨转移为M1，无骨转移为M0）独立对骨状态进行分类。基于根治性前列腺切除术后的前列腺特异性抗原反应和/或补充影像学检查，部分患者有真实的参考标准。
以BSI >0作为转移的临界值进行软件分析，结果显示与专家对M1疾病的分类具有高度一致性（96%的患者），但与M0疾病的一致性一般（38%）。当BSI >1时，M1的一致性为58%，M0的一致性为98%。基于欧洲泌尿外科学会个体风险分类的软件分析并未提高诊断性能。在有真实参考标准的患者中，该软件在64%的M0患者中显示有转移，但在所有M1患者中正确分类了转移情况。与BSI >1时的66.7%、97.8%、72.7%和97.0%相比，BSI >0时的敏感性为100%，特异性为36%，阳性预测值为12.6%，阴性预测值为100%。
在新诊断前列腺癌的分期中，使用EXINI Bone软件计算BSI的诊断价值有限。
