Borofsky Samuel, George Arvin K, Gaur Sonia, Bernardo Marcelino, Greer Matthew D, Mertan Francesca V, Taffel Myles, Moreno Vanesa, Merino Maria J, Wood Bradford J, Pinto Peter A, Choyke Peter L, Turkbey Baris
From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.).
Radiology. 2018 Jan;286(1):186-195. doi: 10.1148/radiol.2017152877. Epub 2017 Oct 20.
Purpose To characterize clinically important prostate cancers missed at multiparametric (MP) magnetic resonance (MR) imaging. Materials and Methods The local institutional review board approved this HIPAA-compliant retrospective single-center study, which included 100 consecutive patients who had undergone MP MR imaging and subsequent radical prostatectomy. A genitourinary pathologist blinded to MP MR findings outlined prostate cancers on whole-mount pathology slices. Two readers correlated mapped lesions with reports of prospectively read MP MR images. Readers were blinded to histopathology results during prospective reading. At histopathologic examination, 80 clinically unimportant lesions (<5 mm; Gleason score, 3+3) were excluded. The same two readers, who were not blinded to histopathologic findings, retrospectively reviewed cancers missed at MP MR imaging and assigned a Prostate Imaging Reporting and Data System (PI-RADS) version 2 score to better understand false-negative lesion characteristics. Descriptive statistics were used to define patient characteristics, including age, prostate-specific antigen (PSA) level, PSA density, race, digital rectal examination results, and biopsy results before MR imaging. Student t test was used to determine any demographic differences between patients with false-negative MP MR imaging findings and those with correct prospective identification of all lesions. Results Of the 162 lesions, 136 (84%) were correctly identified with MP MR imaging. Size of eight lesions was underestimated. Among the 26 (16%) lesions missed at MP MR imaging, Gleason score was 3+4 in 17 (65%), 4+3 in one (4%), 4+4 in seven (27%), and 4+5 in one (4%). Retrospective PI-RADS version 2 scores were assigned (PI-RADS 1, n = 8; PI-RADS 2, n = 7; PI-RADS 3, n = 6; and PI-RADS 4, n = 5). On a per-patient basis, MP MR imaging depicted clinically important prostate cancer in 99 of 100 patients. At least one clinically important tumor was missed in 26 (26%) patients, and lesion size was underestimated in eight (8%). Conclusion Clinically important lesions can be missed or their size can be underestimated at MP MR imaging. Of missed lesions, 58% were not seen or were characterized as benign findings at second-look analysis. Recognition of the limitations of MP MR imaging is important, and new approaches to reduce this false-negative rate are needed. RSNA, 2017 Online supplemental material is available for this article.
目的 对多参数（MP）磁共振（MR）成像漏诊的具有临床重要性的前列腺癌进行特征分析。材料与方法 本机构当地的审查委员会批准了这项符合健康保险流通与责任法案（HIPAA）的回顾性单中心研究，该研究纳入了100例连续接受MP MR成像及随后根治性前列腺切除术的患者。一位对MP MR检查结果不知情的泌尿生殖病理学家在全层病理切片上勾勒出前列腺癌。两名阅片者将标注的病灶与前瞻性阅读的MP MR影像报告进行对照。阅片者在进行前瞻性阅读时对组织病理学结果不知情。在组织病理学检查时，排除80个临床不重要的病灶（<5 mm；Gleason评分3+3）。同样的两名阅片者，此时对组织病理学结果已不再不知情，他们回顾性地复查MP MR成像漏诊的癌症，并给予前列腺影像报告和数据系统（PI-RADS）第2版评分，以更好地了解假阴性病灶的特征。采用描述性统计来定义患者特征，包括年龄、前列腺特异性抗原（PSA）水平、PSA密度、种族、直肠指检结果以及MR成像前的活检结果。采用学生t检验来确定MP MR成像假阴性结果的患者与所有病灶均被正确前瞻性识别的患者之间的任何人口统计学差异。结果 在162个病灶中，136个（84%）通过MP MR成像被正确识别。8个病灶的大小被低估。在MP MR成像漏诊的26个（16%）病灶中，Gleason评分为3+4的有17个（65%），4+3的有1个（4%），4+4的有7个（27%），4+5的有1个（4%）。回顾性地给出了PI-RADS第2版评分（PI-RADS 1，n = 8；PI-RADS 2，n = 在每位患者层面，MP MR成像在100例患者中的99例中显示出具有临床重要性的前列腺癌。26例（26%）患者至少有一个具有临床重要性的肿瘤被漏诊，8例（8%）患者的病灶大小被低估。结论 在MP MR成像时，具有临床重要性的病灶可能被漏诊，或者其大小可能被低估。在漏诊的病灶中，58%在二次分析时未被发现或被判定为良性表现。认识到MP MR成像的局限性很重要，需要新的方法来降低这种假阴性率。RSNA，2017 本文有在线补充材料。
