多参数磁共振成像对不可逆电穿孔局灶治疗后残余前列腺癌的初步诊断准确性。

Preliminary Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Detect Residual Prostate Cancer Following Focal Therapy with Irreversible Electroporation.

机构信息

Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia; Academic Medical Center, Department of Urology, University of Amsterdam, The Netherlands.

出版信息

Eur Urol Focus. 2019 Jul;5(4):585-591. doi: 10.1016/j.euf.2017.10.007.

DOI:10.1016/j.euf.2017.10.007

PMID:29102671

Abstract

BACKGROUND

It is recommended to perform multiparametric magnetic resonance imaging (mpMRI) in the follow-up following focal therapy of prostate cancer (PCa).

OBJECTIVE

To determine the diagnostic accuracy of mpMRI to detect residual PCa following focal therapy with irreversible electroporation.

DESIGN, SETTING, AND PARTICIPANTS: Seventy-six patients with biopsy-proven localized PCa consented for primary irreversible electroporation between February 2013 and March 2016. Final analysis was performed on 50 patients that received follow-up mpMRI at 6 mo, serial prostate-specific antigen (PSA) testing, and transperineal template-mapping biopsies at 12 mo.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Outfield regions of interest (ROI) were reported using PI-RADS version 2. A binary outcome (suspicious vs nonsuspicious) was given for the infield ablation zone. Sensitivity, specificity, positive predictive values, and negative predictive values were calculated for different definitions of significant PCa: (1) Gleason ≥4+3 or Gleason ≥3+3 with a maximum cancer core length ≥6mm, (2) Gleason ≥3+4 or Gleason ≥3+3 with a maximum cancer core length ≥4mm, for outfield and infield ROI. Multivariate linear regression analyses evaluated the additional value of nadir PSA.

RESULTS AND LIMITATIONS

Sensitivity, specificity, positive predictive values, and negative predictive values of infield ROI was 43%, 86%, 33%, and 90% for definition 1 and 38%, 86%, 33%, and 88% for definition 2, respectively. For outfield ROI this was 33%, 82%, 20%, and 90% for definition 1 and 38%, 86%, 50%, and 80% for definition 2. PSA had no additional value in predicting residual significant PCa. Limitations include retrospective design, single reader, and low incidence of residual PCa.

CONCLUSIONS

Our preliminary data suggest that mpMRI can rule out high-volume residual PCa. However, follow-up biopsies should still be performed to determine oncological control.

PATIENT SUMMARY

Multiparametric magnetic resonance imaging is able to detect high-volume significant prostate cancer following focal therapy. Prostate biopsies are still required in the follow-up of focal therapy as (low-volume) significant prostate cancer is being missed by multiparametric magnetic resonance imaging.

摘要

背景

建议对前列腺癌（PCa）的局灶性治疗后进行多参数磁共振成像（mpMRI）随访。

目的

确定 mpMRI 检测不可逆电穿孔局灶性治疗后残留 PCa 的诊断准确性。

设计、地点和参与者：2013 年 2 月至 2016 年 3 月期间，76 例经活检证实的局限性 PCa 患者同意行原发性不可逆电穿孔治疗。最终分析了 50 例患者，这些患者在 6 个月时接受了随访 mpMRI、连续前列腺特异性抗原（PSA）检测和 12 个月时经会阴模板映射活检。

结果测量和统计分析

使用 PI-RADS 版本 2 报告场外感兴趣区（ROI）。对于场内消融区，给出可疑与非可疑的二进制结果。对于不同定义的显著 PCa，计算了场外和场内 ROI 的敏感性、特异性、阳性预测值和阴性预测值：（1）Gleason≥4+3 或 Gleason≥3+3 且最大癌核心长度≥6mm，（2）Gleason≥3+4 或 Gleason≥3+3 且最大癌核心长度≥4mm。多变量线性回归分析评估了 PSA 最低值的附加价值。

结果和局限性

场内 ROI 的敏感性、特异性、阳性预测值和阴性预测值分别为定义 1 的 43%、86%、33%和 90%，定义 2 的 38%、86%、33%和 88%。对于场外 ROI，定义 1 为 33%、82%、20%和 90%，定义 2 为 38%、86%、50%和 80%。PSA 在预测残留显著 PCa 方面没有额外价值。局限性包括回顾性设计、单读片者和残留 PCa 发生率低。