Centre for Medical Imaging, University College London Hospitals NHS Foundation Trust, University College London, London, UK.
Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, Hertfordshire, UK.
BJU Int. 2018 Jul;122(1):13-25. doi: 10.1111/bju.14361. Epub 2018 Jun 5.
To identify areas of agreement and disagreement in the implementation of multi-parametric magnetic resonance imaging (mpMRI) of the prostate in the diagnostic pathway.
Fifteen UK experts in prostate mpMRI and/or prostate cancer management across the UK (involving nine NHS centres to provide for geographical spread) participated in a consensus meeting following the Research and Development Corporation and University of California-Los Angeles (UCLA-RAND) Appropriateness Method, and were moderated by an independent chair. The experts considered 354 items pertaining to who can request an mpMRI, prostate mpMRI protocol, reporting guidelines, training, quality assurance (QA) and patient management based on mpMRI levels of suspicion for cancer. Each item was rated for agreement on a 9-point scale. A panel median score of ≥7 constituted 'agreement' for an item; for an item to reach 'consensus', a panel majority scoring was required.
Consensus was reached on 59% of items (208/354); these were used to provide recommendations for the implementation of prostate mpMRI in the UK. Key findings include prostate mpMRI requests should be made in consultation with the urological team; mpMRI scanners should undergo QA checks to guarantee consistently high diagnostic quality scans; scans should only be reported by trained and experienced radiologists to ensure that men with unsuspicious prostate mpMRI might consider avoiding an immediate biopsy.
Our consensus statements demonstrate a set of criteria that are required for the practical dissemination of consistently high-quality prostate mpMRI as a diagnostic test before biopsy in men at risk.
确定在前列腺多参数磁共振成像（mpMRI）的诊断途径中实施方面的共识和分歧领域。
来自英国的 15 名前列腺 mpMRI 和/或前列腺癌管理专家（涉及 9 家 NHS 中心以实现地域分布）参与了一项共识会议，该会议遵循了研究与开发公司和加州大学洛杉矶分校（UCLA-RAND）适宜性方法，并由一位独立主席进行了主持。专家们根据对癌症的 mpMRI 可疑程度，考虑了 354 项与谁可以请求 mpMRI、前列腺 mpMRI 方案、报告指南、培训、质量保证（QA）和患者管理相关的项目。每个项目的同意程度都按照 9 分制进行评分。项目的小组中位数评分≥7 表示“同意”；为了达成“共识”，需要小组多数人的评分。
有 59%的项目（208/354）达成了共识；这些项目被用于为英国实施前列腺 mpMRI 提供建议。主要发现包括前列腺 mpMRI 请求应与泌尿科团队协商进行；mpMRI 扫描仪应进行 QA 检查，以保证始终具有高诊断质量的扫描；扫描只能由经过培训和经验丰富的放射科医生进行报告，以确保对 mpMRI 前列腺无可疑的男性可以考虑避免立即进行活检。
我们的共识声明展示了一套标准，这些标准是在男性风险前进行活检前将一致的高质量前列腺 mpMRI 作为诊断测试实际推广所必需的。
