Division of Urologic Oncology, Department of Urology, NYU Langone-Brooklyn, Brooklyn, NY, USA.
Department of Clinical Research, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.
Eur Urol Focus. 2019 Sep;5(5):815-822. doi: 10.1016/j.euf.2018.05.005. Epub 2018 May 23.
Magnetic resonance imaging (MRI) of the prostate after a prior negative biopsy may reduce the need for unnecessary repeat biopsies.
To externally validate a previously developed nomogram predicting benign prostate pathology on MRI/ultrasound (US) fusion-targeted biopsy in men with a Prostate Imaging Reporting and Data System (PI-RADS) 3-5 region of interest and a prior negative 12-core systematic biopsy, and update this nomogram to improve its performance.
DESIGN, SETTING, AND PARTICIPANTS: A total of 2063 men underwent MRI/US fusion-targeted biopsy from April 2012 to September 2017; 104 men with a negative systematic biopsy followed by MRI-US fusion-targeted biopsy of a PI-RADS 3-5 region of interest (58%) met the study inclusion criteria.
An MRI-based nomogram that had previously been developed in a multi-institutional clinical setting was externally validated. Predictive characteristics were age, prostate volume, MRI PI-RADS score, and prostate-specific antigen (PSA). Bayesian logistic regression was used to update the previous model.
Median age of the external validation cohort was 68 yr, PSA was 7.2ng/ml, and biopsy confirmed benign pathology in 30% (n=31), suggesting a lower baseline risk compared with the nomogram development cohort. Receiver operating characteristic curve analysis showed areas under curve (AUCs) from 0.77 to 0.80 for nomogram validation. An updated model was constructed with improved calibration and similar discrimination (AUC 0.79).
Age, prostate volume, PI-RADS, and PSA predict benign pathology on MRI/US fusion-targeted biopsy in men with a prior negative 12-core systematic biopsy. The validated and updated nomogram demonstrated high diagnostic accuracy and may further aid in the decision to avoid a biopsy in men with a prior negative biopsy.
We externally validated a clinically useful tool that predicts benign prostate pathology on magnetic resonance imaging/ultrasound fusion-targeted biopsy in men with a prior negative 12-core systematic biopsy and updated this predictive tool to improve its performance in patient counseling regarding the need for a repeat biopsy.
在先前进行过阴性活检的前列腺中进行磁共振成像（MRI）可能会减少不必要的重复活检的需求。
在前列腺成像报告和数据系统（PI-RADS）3-5 感兴趣区域和先前进行过阴性 12 核系统活检的男性中，验证先前开发的用于预测 MRI/超声（US）融合靶向活检中良性前列腺病理的列线图，并更新该列线图以提高其性能。
设计、地点和参与者：共有 2063 名男性于 2012 年 4 月至 2017 年 9 月接受 MRI/US 融合靶向活检；104 名男性进行了阴性系统活检，随后对 PI-RADS 3-5 感兴趣区域进行了 MRI-US 融合靶向活检（58%），符合研究纳入标准。
在多机构临床环境中先前开发的基于 MRI 的列线图得到了外部验证。预测特征包括年龄、前列腺体积、MRI PI-RADS 评分和前列腺特异性抗原（PSA）。使用贝叶斯逻辑回归更新了先前的模型。
外部验证队列的中位年龄为 68 岁，PSA 为 7.2ng/ml，活检证实良性病变 30%（n=31），与列线图开发队列相比，基线风险较低。受试者工作特征曲线分析显示，列线图验证的曲线下面积（AUCs）为 0.77 至 0.80。构建了一个更新的模型，其校准和区分度均有所提高（AUC 为 0.79）。
年龄、前列腺体积、PI-RADS 和 PSA 预测了先前进行过阴性 12 核系统活检的男性中 MRI/US 融合靶向活检中的良性病理。验证和更新的列线图具有较高的诊断准确性，可能有助于进一步帮助决定避免对先前进行过阴性活检的男性进行活检。
我们对外科有用的工具进行了验证，该工具可预测先前进行过阴性 12 核系统活检的男性中 MRI/超声融合靶向活检中的良性前列腺病理，并更新了该预测工具，以提高其在患者重复活检必要性方面的咨询效果。
