Hoffmann Manuela A, Wieler Helmut J, Jakobs Frank M, Taymoorian Kasra, Gerhards Arnd, Miederer Matthias, Schreckenberger Mathias
Supervisory Center for Medical Radiation Protection, Bundeswehr Medical Service Headquarters, Koblenz, Germany, Tel: +49 (0) 261-896 26320, E-Mail:
Department of Nuclear Medicine, University Medical Center Mainz, Mainz, Germany
Nuklearmedizin. 2017 Aug 14;56(4):147-155. doi: 10.3413/Nukmed-0871-16-12. Epub 2017 Jul 17.
To increase diagnostic precision and to reduce overtreatment of low-risk malignant disease, multiparametric MRI (mpMRI) combined with ultrasound (US) fusion guided biopsy of the prostate were performed.
In 99 male patients with increased PSA plasma levels and previous negative standard biopsy procedures, mpMRI was carried out followed by US fusion guided perineal biopsy. PI-RADS-Data (PS) of mpMRI and histopathological Gleason score (GS) were categorized and statistically compared.
Lesions in 72/99 (73 %) of patients were determined to be suspect of malignancy, based on a PS 4 or 5. In 33/99 (33 %) of patients, malignancy could not be confirmed by histopathology. With regard to the remaining 66 patients with previous negative biopsy results, 42 (64 %) were diagnosed with a low-grade carcinoma (GS 6, 7a) and 24 (36 %) with a high-grade carcinoma (GS ≥ 7b). The proportion of corresponding results in mpMRI (PS 4-5) when a high-grade carcinoma had been detected, was 21/24 (88 %), which related to a sensitivity of 88 % and a negative predictive value (NPV) of 85 % (p = 0,002). In addition, 35 of 42 patients (83%), graded PS 4-5 in mpMRI, were diagnosed with low-grade carcinoma-positive (p < 0,001). Sensitivity to differentiation between low- and high-grade carcinomas (GS ≤ 7a vs. ≥ 7b) by means of PS was 88 % with a NPV of 70 % (p = 0,74).
Our results suggest that mpMRI combined with US-fusion guided biopsy is able to detect considerably higher rates of clinically relevant prostate malignancies compared to conventional diagnostic procedures. However, no statistical significance could be shown regarding the differentiation between high- and low-grade carcinomas. It is hoped that the hybrid methods PSMA-PET/CT or PSMA-PET/MRI will lead to the next optimization step in the differentiation between high- and low-grade carcinomas which so far has been unsatisfactory.
为提高诊断准确性并减少低风险恶性疾病的过度治疗，进行了多参数磁共振成像（mpMRI）联合超声（US）融合引导下的前列腺活检。
对99例前列腺特异性抗原（PSA）血浆水平升高且先前标准活检结果为阴性的男性患者，先进行mpMRI检查，随后进行US融合引导下的会阴活检。对mpMRI的前列腺影像报告和数据系统（PI-RADS）数据（PS）及组织病理学Gleason评分（GS）进行分类并进行统计学比较。
基于PS 4或5，99例患者中有72/99（73%）的病变被判定为疑似恶性。33/99（33%）的患者经组织病理学检查未确诊为恶性。对于其余66例先前活检结果为阴性的患者，42例（64%）被诊断为低级别癌（GS 6、7a），24例（36%）被诊断为高级别癌（GS≥7b）。检测到高级别癌时，mpMRI中相应结果（PS 4 - 5）的比例为21/24（88%），敏感性为88%，阴性预测值（NPV）为85%（p = 0.002）。此外，42例患者中有35例（83%）在mpMRI中PS分级为4 - 5，被诊断为低级别癌阳性（p < 0.001）。通过PS区分低级别和高级别癌（GS≤7a与≥7b）的敏感性为88%，NPV为70%（p = 0.74）。
我们的结果表明，与传统诊断方法相比，mpMRI联合US融合引导活检能够检测出更高比例的临床相关前列腺恶性肿瘤。然而，在高级别和低级别癌的区分方面未显示出统计学意义。希望PSMA - PET/CT或PSMA - PET/MRI等混合方法将引领迄今为止仍不尽人意的高级别和低级别癌区分的下一步优化。
