Department of Urology, University of Rochester Medical Center, Rochester, New York.
Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Cancer. 2018 Jan 15;124(2):278-285. doi: 10.1002/cncr.31051. Epub 2017 Oct 4.
Prostate multiparametric magnetic resonance imaging (mpMRI) may be recommended for patients with a prior negative systematic biopsy (SB). However, a proportion of these patients will continue to have no prostate cancer (PCa) identified on magnetic resonance/ultrasound fusion biopsy (FB) despite abnormal mpMRI findings.
In this multi-institutional, retrospective study, clinical and mpMRI parameters were assessed for 285 consecutive patients with at least 1 prior negative biopsy who underwent FB for a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 to 5 at the University of Rochester Medical Center from December 2014 to December 2016, or at the University of Alabama at Birmingham from February 2014 to February 2017. Nomograms were generated for predicting benign prostate pathology on both the targeted biopsy and the concurrent SB.
Benign pathology was found in 132 of 285 patients (46.3%). In a multivariate analysis, the predictors of benign prostate pathology on FB were age, prostate-specific antigen, prostate volume, and PI-RADS score. The predicted probabilities were plotted on a receiver operating characteristic curve, and the area under the curve was 0.825. The nomogram demonstrated excellent calibration and a high net benefit in a decision curve analysis. With a theoretical cutoff probability of ≥0.7 used to recommend deferment of FB, 61 of 285 patients (21.4%) would have avoided an unnecessary biopsy, and only 4 of 285 patients (1.4%) with PCa with a Gleason score ≥ 3 + 4 would have been missed.
False-positive mpMRI examinations may occur in up to 46.3% of patients with a prior negative biopsy. Thus, a multi-institutional nomogram has been developed and validated for predicting benign pathology after FB in patients with a prior negative biopsy, and this may help to reduce the number of unnecessary biopsies in the setting of abnormal mpMRI findings. Cancer 2018;124:278-85. © 2017 American Cancer Society.
前列腺多参数磁共振成像（mpMRI）可能会推荐给先前有过阴性系统活检（SB）的患者。然而，尽管 mpMRI 结果异常，这些患者中有一部分在磁共振/超声融合活检（FB）上仍未发现前列腺癌（PCa）。
在这项多机构、回顾性研究中，评估了 285 例连续患者的临床和 mpMRI 参数，这些患者在罗切斯特大学医学中心（2014 年 12 月至 2016 年 12 月）或阿拉巴马大学伯明翰分校（2014 年 2 月至 2017 年 2 月）接受过至少一次阴性活检，且前列腺成像报告和数据系统（PI-RADS）评分为 3 至 5 分，行 FB 检查。为靶向活检和同期 SB 生成了预测良性前列腺病理的列线图。
285 例患者中有 132 例（46.3%）发现良性病变。多变量分析显示，FB 上良性前列腺病理的预测因素为年龄、前列腺特异性抗原、前列腺体积和 PI-RADS 评分。预测概率绘制在接受者操作特征曲线（ROC）上，曲线下面积为 0.825。列线图在决策曲线分析中显示出良好的校准和高净收益。使用理论截断概率≥0.7 来推荐 FB 延期，285 例患者中有 61 例（21.4%）可以避免不必要的活检，而 285 例患者中仅有 4 例（1.4%）有 Gleason 评分≥3+4 的 PCa 会被遗漏。
先前有过阴性活检的患者中，高达 46.3%的 mpMRI 检查可能出现假阳性。因此，已经开发和验证了一种多机构列线图，用于预测先前有过阴性活检患者 FB 后的良性病理，这可能有助于减少异常 mpMRI 结果患者中不必要的活检数量。癌症 2018;124:278-85。© 2017 美国癌症协会。
