VU University Medical Center, Amsterdam, The Netherlands.
Maasstad Ziekenhuis, Rotterdam, The Netherlands.
World J Urol. 2018 Sep;36(9):1409-1415. doi: 10.1007/s00345-018-2295-6. Epub 2018 Apr 21.
To estimate the diagnostic accuracy of multiparametric MRI (mpMRI) for the detection of locally advanced prostate cancer (T-stage 3-4) prior to radical prostatectomy, in a multicenter cohort representing daily clinical practice. In addition, the radiologic learning curve for the detection of locally advanced disease is evaluated.
Preoperative mpMRI findings of 430 patients (2012-2016) were compared to pathology results following radical prostatectomy. The diagnostic accuracy (sensitivity, specificity, PPV, and NPV) for the detection of locally advanced disease was calculated and compared for all years separately, to evaluate the presence of a radiological learning curve.
Of all 137 patients with locally advanced disease, 62 patients were preoperatively detected with mpMRI [sensitivity 45.3% (95% CI 36.9-53.6%), specificity 75.8% (CI 70.9-80.7%), PPV 46.6% (CI 38.1-55.1%), and NPV 74.7% (CI 69.8-79.7%)]. The diagnostic accuracy did not improve significantly over time (sensitivity p = 0.12; specificity p = 0.57).
In daily clinical practice, the diagnostic accuracy of mpMRI for the detection of locally advanced prostate cancer remains limited. It, therefore, seems questionable whether mpMRI is adequate to guide preoperative decision-making. No significant radiologic learning curve for the detection of locally advance disease was observed.
在代表日常临床实践的多中心队列中，评估多参数 MRI（mpMRI）在根治性前列腺切除术前检测局部晚期前列腺癌（T 期 3-4 期）的诊断准确性。此外，还评估了检测局部晚期疾病的放射学学习曲线。
将 430 例患者（2012-2016 年）的术前 mpMRI 结果与根治性前列腺切除术后的病理结果进行比较。计算并比较了所有年份分别检测局部晚期疾病的诊断准确性（敏感性、特异性、PPV 和 NPV），以评估是否存在放射学学习曲线。
在所有 137 例局部晚期疾病患者中，62 例患者术前通过 mpMRI 检测到[敏感性 45.3%（95%CI 36.9-53.6%），特异性 75.8%（CI 70.9-80.7%），PPV 46.6%（CI 38.1-55.1%）和 NPV 74.7%（CI 69.8-79.7%）]。诊断准确性随时间的推移并未显著提高（敏感性 p=0.12；特异性 p=0.57）。
在日常临床实践中，mpMRI 检测局部晚期前列腺癌的诊断准确性仍然有限。因此，mpMRI 是否足以指导术前决策似乎值得怀疑。未观察到检测局部进展性疾病的明显放射学学习曲线。
