[根治性前列腺切除术前行多参数磁共振成像（MRI）时可见及不可见肿瘤的病理结果]
[Pathological findings of visible and non-visible tumors on multiparametric magnetic resonance imaging (MRI) prior to radical prostatectomy].
作者信息
Rivière A, Cornud F, Beuvon F, Sibony M, Legmann P, Barry Delongchamps N
机构信息
Service d'urologie, hôpital Cochin Port-Royal, université Paris-Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Service de radiologie, hôpital Cochin Port-Royal, université Paris-Descartes, France.
出版信息
Prog Urol. 2017 Sep;27(10):536-542. doi: 10.1016/j.purol.2017.07.004. Epub 2017 Sep 1.
INTRODUCTION
As urologists are questioned about the overtreatment of localized prostate cancer, multiparametric MRI can diagnose significant prostate cancer thanks to targeted biopsies. However, some tumors cannot be detected by MRI. What are the pathological characteristics of those tumors?
MATERIALS AND METHODS
We have selected 144 consecutive patients treated with radical prostatectomy for clinically localized prostate cancer diagnosed on systematic and targeted biopsies (Koelis) according to multiparametric MRI findings. On MRI, each suspicious area was graded according to the PI-RADS score v1.0. On radical prostatectomy specimen, tumor foci with a Gleason score greater than 3+3 and/or a tumor volume greater than 0,5cm were considered significant. The grade-four tumoral volume was calculated by multiplying the tumoral volume by grade 4 tumoral percentage.
RESULTS
Two hundred and seventy seven tumors were identified. A hundred and thirty nine were non-visible on MRI. They had a significantly lower volume (0.15cm versus 1.45cm, P<0.0001) and a Gleason score significantly lower (P<0.0001) than apparent tumors. 17.3% of non-apparent tumors were significant. Moreover, the grade-four tumoral volume of significant non-apparent tumors was significantly lower than that of significant apparent tumors (0.11cm versus 0.66cm, P<0.0001).
CONCLUSION
Non-apparent prostate tumors on multiparametric MRI have a Gleason score, a tumor volume - and consequently - a grade 4 tumor volume significantly lower than apparent tumors.
LEVEL OF PROOF
引言
随着泌尿外科医生面临局部前列腺癌过度治疗的质疑，多参数磁共振成像（MRI）借助靶向活检能够诊断出显著的前列腺癌。然而，一些肿瘤无法通过MRI检测到。这些肿瘤的病理特征是什么？
材料与方法
我们选取了144例连续接受根治性前列腺切除术的患者，这些患者根据多参数MRI结果在系统活检和靶向活检（Koelis）中被诊断为临床局限性前列腺癌。在MRI上，每个可疑区域根据前列腺影像报告和数据系统（PI-RADS）v1.0评分进行分级。在根治性前列腺切除标本上，Gleason评分大于3+3和/或肿瘤体积大于0.5cm的肿瘤灶被视为显著。四级肿瘤体积通过将肿瘤体积乘以四级肿瘤百分比来计算。
结果
共识别出277个肿瘤。其中139个在MRI上不可见。它们的体积（0.15cm对1.45cm，P<0.0001）和Gleason评分显著低于可见肿瘤（P<0.0001）。17.3%的不可见肿瘤是显著的。此外，显著不可见肿瘤的四级肿瘤体积显著低于显著可见肿瘤（0.11cm对0.66cm，P<0.0001）。
结论
多参数MRI上不可见的前列腺肿瘤的Gleason评分、肿瘤体积以及四级肿瘤体积均显著低于可见肿瘤。
证据水平
4级。
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