前列腺管内癌（IDC-P）降低了中等风险前列腺癌的表观扩散系数（ADC）值。
Intraductal carcinoma of the prostate (IDC-P) lowers apparent diffusion coefficient (ADC) values among intermediate risk prostate cancers.
机构信息
Department of Medical Imaging, Ottawa Hospital, Ottawa, Ontario, Canada.
Department of Anatomical Pathology, Ottawa Hospital, Ottawa, Ontario, Canada.
出版信息
J Magn Reson Imaging. 2019 Jul;50(1):279-287. doi: 10.1002/jmri.26594. Epub 2018 Dec 25.
BACKGROUND
Prostatic intraductal carcinoma (IDC-P) is an aggressive variant of prostate cancer (PCa) characterized by proliferation of malignant cells within prostatic ducts/acini and nucleomegaly.
PURPOSE/HYPOTHESIS: To compare apparent diffusion coefficient (ADC) values and Prostate Imaging and Data Reporting System (PI-RADS) v. 2 scores in intermediate risk (International Society of Urological Pathology [ISUP] Grade Group [GG] 2 and 3) PCa with/without IDC-P to determine if IDC-P alters the MRI appearance of PCa.
STUDY TYPE
Retrospective, case-control.
POPULATION
Fifteen consecutive men with ISUP GG 2/3 (Gleason score 3+4 = 7 [N = 4], 4+3 = 7 [N = 11]) PCa with IDC-P diagnosed at radical prostatectomy were compared with: 1) ISUP GG 2/3 PCa without IDC-P (matched for percentage Gleason pattern 4), and 2) ISUP GG 4 and 5 (Gleason score 8/9) PCa without IDC-P.
FIELD STRENGTH/SEQUENCE: 3T multiparametric MRI.
ASSESSMENT
Two blinded radiologists (R1/R2) measured mean ADC, ADC.ratio (ADC.tumor/ADC.normal peripheral zone) and assigned PI-RADS v2 scores. Statistical Tests: Chi-square and analysis of variance (ANOVA).
RESULTS
There were no differences in age, prostate serum antigen, tumor size, or stage between groups (P = 0.063-0.912). Tumors with IDC-P had lower mean ADC and ADC.ratio (0.741 ± 0.152 mm /sec and 0.44 ± 0.07) compared with ISUP GG 2/3 tumors without IDC-P (0.888 ± 0.167 mm /sec and 0.62 ± 0.14), P = 0.012 and <0.001; and did not differ compared with ISUP GG 4/5 tumors (0.705 ± 0.141 mm /sec and 0.44 ± 0.08), P = 0.509 and 0.868. Tumors with IDC-P were nearly all PI-RADS v2 score 5 (14/15) compared with ISUP GG 2/3 tumors without IDC-P (10/15 R1, 8/15 R2) and GG 4/5 tumors (9/15), (P = 0.040 = 0.092). Agreement in PI-RADS v2 scoring was moderate (K = 0.68).
DATA CONCLUSION
ISUP GG 2 and 3 (intermediate risk, Gleason score 7) PCa with IDC-P have lower ADC compared with tumors without IDC-P with a similar percentage of Gleason pattern 4 and resemble ISUP GG 4 and 5 high risk tumors on MRI. IDC-P lowers ADC values among intermediate risk prostate cancers.
LEVEL OF EVIDENCE
3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:279-287.
背景
前列腺管内癌（IDC-P）是一种侵袭性前列腺癌（PCa）变异型，其特征为前列腺导管/腺泡内恶性细胞增殖和核增大。
目的/假设：比较中危（国际泌尿病理学会[ISUP]分级组[GG] 2 和 3）伴或不伴 IDC-P 的 PCa 的表观扩散系数（ADC）值和前列腺影像报告和数据系统（PI-RADS）v.2 评分，以确定 IDC-P 是否改变了 PCa 的 MRI 表现。
研究类型
回顾性、病例对照。
人群
15 例连续接受根治性前列腺切除术的 ISUP GG 2/3（Gleason 评分 3+4=7[N=4]，4+3=7[N=11]）伴 IDC-P 的 PCa 患者与：1）无 IDC-P 的 ISUP GG 2/3 PCa（按 Gleason 模式 4 的百分比匹配），2）无 IDC-P 的 ISUP GG 4 和 5（Gleason 评分 8/9）PCa 进行比较。
磁场强度/序列：3T 多参数 MRI。
评估
两位盲法放射科医生（R1/R2）测量平均 ADC、ADC.ratio（ADC.肿瘤/ADC.正常外周带）并分配 PI-RADS v2 评分。统计检验：卡方检验和方差分析（ANOVA）。
结果
各组间年龄、前列腺血清抗原、肿瘤大小或分期无差异（P=0.063-0.912）。伴 IDC-P 的肿瘤平均 ADC 和 ADC.ratio 较低（0.741±0.152mm/sec 和 0.44±0.07），与无 IDC-P 的 ISUP GG 2/3 肿瘤相比（0.888±0.167mm/sec 和 0.62±0.14），P=0.012 和 <0.001；与 ISUP GG 4/5 肿瘤相比无差异（0.705±0.141mm/sec 和 0.44±0.08），P=0.509 和 0.868。伴 IDC-P 的肿瘤几乎均为 PI-RADS v2 评分 5（14/15），与无 IDC-P 的 ISUP GG 2/3 肿瘤（R1 为 10/15，R2 为 8/15）和 ISUP GG 4/5 肿瘤（9/15）相比，P=0.040=0.092）。PI-RADS v2 评分的一致性为中度（K=0.68）。
数据结论
伴 IDC-P 的 ISUP GG 2 和 3（中危，Gleason 评分 7）PCa 的 ADC 低于无 IDC-P 的肿瘤，其 Gleason 模式 4 的百分比相似，在 MRI 上与 ISUP GG 4 和 5 高危肿瘤相似。IDC-P 降低了中危前列腺癌的 ADC 值。
证据水平
3 技术功效阶段：2 J. Magn. Reson. Imaging 2019；50：279-287。
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