Shin Toshitaka, Smyth Thomas B, Ukimura Osamu, Ahmadi Nariman, de Castro Abreu Andre Luis, Ohe Chisato, Oishi Masakatsu, Mimata Hiromitsu, Gill Inderbir S
USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Urology, Oita University, Oita, Japan.
BJU Int. 2018 Jan;121(1):77-83. doi: 10.1111/bju.13972. Epub 2017 Aug 16.
To evaluate the accuracy of a magnetic resonance imaging (MRI)-based Likert scoring system in the detection of clinically significant prostate cancer (CSPC), using MRI/ultrasonography (US) image-fusion targeted biopsy (FTB) as a reference standard.
We retrospectively reviewed 1218 MRI-detected lesions in 629 patients who underwent subsequent MRI/US FTB between October 2012 and August 2015. 3-Tesla MRI was independently reported by one of eight radiologists with varying levels of experience and scored on a five-point Likert scale. All lesions with Likert scores 1-5 were prospectively defined as targets for MRI/US FTB. CSPC was defined as Gleason score ≥7.
The median patient age was 64 years, PSA level 6.97 ng/mL and estimated prostate volume 52.2 mL. Of 1218 lesions, 48% (n = 581) were rated as Likert 1-2, 35% (n = 428) were Likert 3 and 17% (n = 209) were Likert 4-5. For Likert scores 1-5, the overall cancer detection rates were 12%, 13%, 22%, 50% and 59%, respectively, and the CSPC detection rates were 4%, 4%, 12%, 33% and 48%, respectively. Grading using the five-point scale showed strong positive correlation with overall cancer detection rate (r = 0.949, P = 0.05) and CSPC detection rate (r = 0.944, P = 0.05). By comparison, in Likert 4-5 lesions, significant differences were noted in overall cancer detection rate (63% vs 35%; P = 0.001) and CSPC detection rate (47% vs 29%; P = 0.027) for the more experienced vs the less experienced radiologists.
The detection rates of overall cancer and CSPC strongly correlated with the five-point grading of the Likert scale. Among radiologists with different levels of experience, there were significant differences in these cancer detection rates.
以磁共振成像（MRI）/超声（US）图像融合靶向活检（FTB）作为参考标准，评估基于MRI的李克特评分系统在检测临床显著前列腺癌（CSPC）中的准确性。
我们回顾性分析了2012年10月至2015年8月期间629例接受后续MRI/US FTB的患者中1218个MRI检测到的病变。由八位经验水平各异的放射科医生之一独立报告3特斯拉MRI，并采用五点李克特量表进行评分。所有李克特评分为1-5分的病变均被前瞻性地定义为MRI/US FTB的靶点。CSPC定义为Gleason评分≥7分。
患者中位年龄为64岁，前列腺特异性抗原（PSA）水平为6.97 ng/mL，估计前列腺体积为52.2 mL。在1218个病变中，48%（n = 581）被评为李克特1-2分，35%（n = 428）为李克特3分，17%（n = 209）为李克特4-5分。对于李克特评分1-5分，总体癌症检出率分别为12%、13%、22%、50%和59%，CSPC检出率分别为4%、4%、12%、33%和48%。使用五点量表进行分级与总体癌症检出率（r = 0.949，P = 0.05）和CSPC检出率（r = 0.944，P = 0.05）呈强正相关。相比之下，在李克特4-5分的病变中，经验较丰富与经验较少的放射科医生在总体癌症检出率（63%对35%；P = 0.001）和CSPC检出率（47%对29%；P = 0.027）方面存在显著差异。
总体癌症和CSPC的检出率与李克特量表的五点分级密切相关。在经验水平不同的放射科医生中，这些癌症检出率存在显著差异。
