Department of Pathology, University Health Network, Toronto, Ontario, Canada.
Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.
J Urol. 2018 Jul;200(1):104-113. doi: 10.1016/j.juro.2018.01.081. Epub 2018 Feb 2.
The aim of this study was to compare biopsy detection of intraductal and cribriform pattern invasive prostate carcinoma in multiparametric magnetic resonance imaging positive and negative regions of the prostate.
We queried a prospectively maintained, single institution database to identify patients who underwent multiparametric magnetic resonance imaging/ultrasound fusion targeted biopsy and concurrent systematic sextant biopsy of magnetic resonance imaging negative regions between January 2013 and May 2016. All multiparametric magnetic resonance imaging targets were reviewed retrospectively by 2 readers for the PI-RADS™ (Prostate Imaging-Reporting and Data System), version 2 score, the maximum dimension, the apparent diffusion coefficient parameter and whether positive or negative on dynamic contrast enhancement sequence. Biopsy slides were reviewed by 2 urological pathologists for Gleason score/Grade Group and the presence or absence of an intraductal/cribriform pattern.
A total of 154 patients were included in study. Multiparametric magnetic resonance imaging/ultrasound fusion targeted biopsy and systematic sextant biopsy of magnetic resonance imaging negative regions were negative for prostate carcinoma in 51 patients, leaving 103 available for the correlation of multiparametric magnetic resonance imaging and the intraductal/cribriform pattern. Prostate carcinoma was identified by multiparametric magnetic resonance imaging/ultrasound fusion targeted biopsy in 93 cases and by systematic sextant biopsy of magnetic resonance imaging negative regions in 76 (p = 0.008). Intraductal/cribriform positive tumor was detected in 23 cases, including at the multiparametric magnetic resonance imaging/ultrasound fusion targeted biopsy site in 22 and at the systematic sextant biopsy of magnetic resonance imaging negative region site in 3 (p <0.001). The intraductal/cribriform pattern was significantly associated with a PI-RADS score of 5 and a decreasing apparent diffusion coefficient value (p = 0.008 and 0.005, respectively). In 19 of the 23 cases with the intraductal/cribriform pattern prior 12-core standard systematic biopsy was negative in 8 and showed Grade Group 1 disease in 11.
Multiparametric magnetic resonance imaging/ultrasound fusion targeted biopsy was associated with significantly increased detection of intraductal/cribriform positive prostate carcinoma compared to systematic sextant biopsy of multiparametric magnetic resonance imaging negative regions. This supports the role of magnetic resonance imaging to enhance the detection of clinically aggressive intraductal/cribriform positive prostate carcinoma.
本研究旨在比较多参数磁共振成像阳性和阴性前列腺区域的前列腺导管内和筛状浸润性前列腺癌的活检检测。
我们查询了一个前瞻性的、单一机构的数据库，以确定 2013 年 1 月至 2016 年 5 月期间接受多参数磁共振成像/超声融合靶向活检和多参数磁共振成像阴性区域系统六分法活检的患者。由 2 位读者对所有多参数磁共振成像靶标进行回顾性分析，评估 PI-RADS（前列腺成像报告和数据系统）评分、最大直径、表观扩散系数参数以及动态对比增强序列的阳性或阴性。由 2 位泌尿病理学家对 Gleason 评分/分级组和是否存在导管内/筛状模式进行活检切片评估。
共有 154 名患者入组研究。多参数磁共振成像/超声融合靶向活检和多参数磁共振成像阴性区域的系统六分法活检在 51 例患者中未检出前列腺癌，103 例可用于多参数磁共振成像与导管内/筛状模式的相关性分析。93 例患者通过多参数磁共振成像/超声融合靶向活检，76 例患者通过多参数磁共振成像阴性区域系统六分法活检检测到前列腺癌（p=0.008）。23 例患者中检测到导管内/筛状阳性肿瘤，其中 22 例在多参数磁共振成像/超声融合靶向活检部位，3 例在多参数磁共振成像阴性区域系统六分法活检部位（p<0.001）。导管内/筛状模式与 PI-RADS 评分 5 和表观扩散系数值降低显著相关（p=0.008 和 0.005）。在 23 例导管内/筛状模式中，19 例在 12 芯标准系统活检前为阴性，8 例为 1 级，11 例为 2 级。
与多参数磁共振成像阴性区域的系统六分法活检相比，多参数磁共振成像/超声融合靶向活检显著增加了导管内/筛状阳性前列腺癌的检出率。这支持磁共振成像在提高对临床侵袭性导管内/筛状阳性前列腺癌的检测中的作用。
