Department of Radiology, University of Colorado SOM, 12401 East 17th Avenue, Mail Stop L954, Aurora, CO, 80045, USA.
Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, CO, 80045, USA.
Abdom Radiol (NY). 2019 Feb;44(2):705-712. doi: 10.1007/s00261-018-1751-5.
To assess the diagnostic accuracy of PI-RADS v2 categories ≥ 3 to detect clinically significant prostate cancer (csPCa) against histopathology of Transperineal Mapping Biopsy (TPMB).
IRB-approved retrospective cohort study included 47 men who had 3.0 T multi-parametric MRI (mpMRI) and TPMB of prostate. Two radiologists independently evaluated T2, DWI, ADC map, and DCE images using PI-RADS v2 categories. A third radiologist served as tie-breaker. PI-RADS v2 score (PS) ≥ 3 lesions were correlated with 3D model of TPMB (3DTPMB) results based on prostate sectors. Two groups of csPCa status were separately analyzed for accuracy measures at lesion and person levels: Group 1 with GS (Gleason Score) ≥ 7 and group 2 with tumor volume ≥ 0.5 cc. Inter-rater reliability for PS and MR lexicon was calculated.
Forty-seven patients with 3DTPMB had at least one lesion with PS ≥ 3 on mpMRI. PS of 5 had high PPV and high specificity of 100% at the lesion and person levels. Sensitivity of a PS ≥ 3 was 68.27% for group 1 and was 48.39% for group 2. Specificity was 93.56% for group 1 and was 95.53% for group 2. At the person level, sensitivity of PS ≥ 3 was 81.25% for group 1 and was 82.35% for group 2. Specificity was 32.26% for group 1 and was 53.85% for group 2.
PI-RADS v2 category of 5 had high PPV and specificity; however, combined PS ≥ 3 had mixed performance in detection of csPCa.
评估 PI-RADS v2 类别≥3 对经会阴前列腺靶向穿刺活检（TPMB）组织病理学的诊断效能，以检测临床显著前列腺癌（csPCa）。
本研究为经机构审查委员会批准的回顾性队列研究，共纳入 47 名接受 3.0T 多参数 MRI（mpMRI）和经会阴前列腺靶向穿刺活检的男性患者。两名放射科医师分别使用 PI-RADS v2 类别独立评估 T2、DWI、ADC 图和 DCE 图像。第三名放射科医师负责裁决。PI-RADS v2 评分（PS）≥3 的病变与基于前列腺区域的 3DTPMB（3DTPMB）结果的 3D 模型相关。分别对 GS（Gleason 评分）≥7 和肿瘤体积≥0.5 cc 的两组 csPCa 患者进行病变和个体水平的准确性评估。计算 PS 和 MR 词汇的组内和组间可靠性。
47 名患者的 3DTPMB 均至少有一个 PS≥3 的病变。PS 为 5 时，病变和个体水平的阳性预测值高（分别为 100%和 81.25%），特异性高（均为 100%）。PS≥3 的敏感度为组 1 的 68.27%，组 2 的 48.39%。组 1 的特异性为 93.56%，组 2 的特异性为 95.53%。在个体水平上，PS≥3 的敏感度为组 1 的 81.25%，组 2 的 82.35%。组 1 的特异性为 32.26%，组 2 的特异性为 53.85%。
PI-RADS v2 类别 5 具有高阳性预测值和特异性；然而，PS≥3 联合检测在检测 csPCa 时表现不一。
