Curci Nicole E, Lane Brian R, Shankar Prasad R, Noyes Sabrina L, Moriarity Andrew K, Kubat Anthony, Brede Chris, Montgomery Jeffrey S, Auffenberg Gregory B, Miller David C, Montie James E, George Arvin K, Davenport Matthew S
Department of Radiology, Michigan Medicine, Ann Arbor, MI.
Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI.
Urology. 2018 Jun;116:137-143. doi: 10.1016/j.urology.2018.02.043. Epub 2018 Apr 10.
To evaluate the integration of 3T nonendorectal coil multiparametric prostate magnetic resonance imaging (mpMRI) at 2 high-volume practices that routinely use mpMRI in the setting of active surveillance.
This was an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, and dual-institution retrospective cohort study. Subjects undergoing 3T mpMRI without endorectal coil at either study institution over a 13-month period (August 1, 2015-August 31, 2016) were selected based on predefined criteria: clinical T1/T2 Gleason 6 prostate cancer, prostate-specific antigen <15 ng/mL, ≥40 years old, mpMRI within 2 years of prostate biopsy, and Prostate Imaging Reporting and Data System (PI-RADS) v2 score assigned. Subjects surveilled for Gleason ≥3 + 4 prostate cancer were excluded. The primary outcome was detection of Gleason ≥3 + 4 prostate cancer on magnetic resonance-ultrasound fusion biopsy, standard biopsy, or prostatectomy within 6 months following mpMRI. Positive predictive values (PPVs) were calculated.
A total of 286 subjects (N = 193 from institution 1, N = 93 from institution 2) met the criteria. Most (87% [90 of 104]) with maximum PI-RADS v2 scores of 1-2 did not receive immediate biopsy or treatment and remained on active surveillance. Incidence and PPVs for PI-RADS v2 scores of ≥3 were the following: PI-RADS 3 (n = 57 [20%], PPV 21% [6 of 29]), PI-RADS 4 (n = 96 [34%], PPV 51% [39 of 77]), and PI-RADS 5 (n = 29 [13%], PPV 71% [20 of 28]). No Gleason ≥4 + 3 prostate cancer was identified for PI-RADS v2 scores of 1-3 (0 of 43 with histology). Following mpMRI and subsequent biopsy, 21% (61 of 286) of subjects were removed from active surveillance and underwent definitive therapy.
The 3T nonendorectal coil mpMRI has been integrated into the care of patients on active surveillance and effectively stratifies risk of Gleason ≥3 + 4 prostate cancer in this population.
评估3T非直肠内线圈多参数前列腺磁共振成像（mpMRI）在2家大量开展主动监测中常规使用mpMRI的医疗机构中的应用情况。
这是一项经机构审查委员会批准、符合《健康保险流通与责任法案》且为双机构的回顾性队列研究。在13个月期间（2015年8月1日至2016年8月31日），在两家研究机构中接受3T非直肠内线圈mpMRI检查的受试者，根据预先确定的标准进行选择：临床T1/T2期Gleason 6前列腺癌、前列腺特异性抗原<15 ng/mL、年龄≥40岁、前列腺活检后2年内进行mpMRI检查且已分配前列腺影像报告和数据系统（PI-RADS）v2评分。排除接受Gleason≥3+4前列腺癌监测的受试者。主要结局是在mpMRI检查后6个月内通过磁共振超声融合活检、标准活检或前列腺切除术检测到Gleason≥3+4前列腺癌。计算阳性预测值（PPV）。
共有286名受试者（机构1有193名，机构2有93名）符合标准。大多数PI-RADS v2最高评分为1-2的受试者（87%[104名中的90名]）未立即接受活检或治疗，仍处于主动监测中。PI-RADS v2评分≥3的发病率和PPV如下：PI-RADS 3（n=57[20%]，PPV 21%[29名中的6名]），PI-RADS 4（n=96[34%]，PPV 51%[77名中的39名]），PI-RADS 5（n=29[13%]，PPV 71%[28名中的20名]）。PI-RADS v2评分为1-3的受试者未发现Gleason≥4+3前列腺癌（43名有组织学检查结果者中0名）。在mpMRI检查及随后的活检后，21%（286名中的61名）受试者被取消主动监测并接受确定性治疗。
3T非直肠内线圈mpMRI已被纳入主动监测患者的护理中，并有效分层了该人群中Gleason≥3+4前列腺癌的风险。
