Bastian-Jordan Matthew
Queensland Xray, Greenslopes Private Hospital, Brisbane, Queensland, Australia.
University of Queensland, Brisbane, Queensland, Australia.
J Med Imaging Radiat Oncol. 2018 Apr;62(2):183-187. doi: 10.1111/1754-9485.12678. Epub 2017 Oct 9.
Multiparametric magnetic resonance imaging (mpMRI) of the prostate has become integral in the investigation of suspected prostate cancer. Regions of interest are graded using the PIRADS scoring system, and in our institution, lesions graded as PIRADS 3-5 undergo sampling by MRI-guided biopsy. Limited data currently exists on PIRADS grading and biopsy results.
Retrospective review of 343 MRI-guided biopsies (MRGB) performed between April 2013 and December 2016 was conducted. This included patients irrespective of whether they were biopsy naïve, biopsy negative or known low-grade malignancy. A Gleason score (G) >= 3+4 was considered to reflect clinically significant disease (CSD).
Of the 18 PIRADS 2 cases (at referrer request) who went to biopsy, 16 were negative and two had small volume Gleason 6 cancer. A total of 75 PIRADS 3 cases were biopsied with 88% negative or small volume Gleason 6 cancer, only 12% yielded ≥ G 3+4. Of the 133 PIRADS 4 lesions, 24% were negative, 25% were G6 and 51% were ≥ G 3+4. A total of 117 PIRADS 5 cases were biopsied with 7% negative, 13% Gleason 6 and 80% considered significant (≥ G 3+4). Of all biopsies, 230 (67%) had a positive result (≥ G6) with 171 of these (75%) being considered CSD, with overall CSD of 50% (171/343).
This paper demonstrates the incidence of CSD for different PIRADS grades. The low incidence of CSD in PIRADS 3 lesions suggests that in low clinical risk men, follow up in priority to biopsy may be an alternative treatment pathway.
前列腺多参数磁共振成像（mpMRI）已成为疑似前列腺癌检查中不可或缺的一部分。使用前列腺影像报告和数据系统（PIRADS）评分系统对感兴趣区域进行分级，在我们机构中，PIRADS 3 - 5级病变通过MRI引导活检进行采样。目前关于PIRADS分级和活检结果的数据有限。
对2013年4月至2016年12月期间进行的343例MRI引导活检（MRGB）进行回顾性分析。这包括无论是否初次活检、活检阴性或已知低级别恶性肿瘤的患者。Gleason评分（G）≥3 + 4被认为反映临床显著疾病（CSD）。
在应转诊医生要求进行活检的18例PIRADS 2级病例中，16例为阴性，2例有小体积Gleason 6级癌。总共75例PIRADS 3级病例接受活检，88%为阴性或小体积Gleason 6级癌，只有12%的病例Gleason评分≥3 + 4。在133例PIRADS 4级病变中，24%为阴性，25%为G6级，51%为Gleason评分≥3 + 4。总共117例PIRADS 5级病例接受活检，7%为阴性，13%为Gleason 6级，80%被认为具有临床意义（Gleason评分≥3 + 4）。在所有活检病例中，230例（67%）结果为阳性（Gleason评分≥6），其中171例（75%）被认为是CSD，总体CSD发生率为50%（171/343）。
本文展示了不同PIRADS分级的CSD发生率。PIRADS 3级病变中CSD发生率较低，这表明在临床风险较低的男性中，活检前优先进行随访可能是一种替代治疗途径。
