Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul 05507, Republic of Korea.
Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul 05507, Republic of Korea.
Clin Imaging. 2019 May-Jun;55:174-180. doi: 10.1016/j.clinimag.2019.03.004. Epub 2019 Mar 8.
To determine the clinical and histopathologic characteristics of missed prostate cancers and their Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score on a pre-biopsy MRI and subsequent MR-ultrasound (US) fusion biopsy.
We analysed 59 prostate cancer patients who underwent a 3-T MRI prior to an MR-US fusion biopsy and subsequent radical prostatectomy. A radiologist initially reviewed these cases to correlate target lesions and pathology-proven lesions. The patients were categorized as detected or missed prostate cancer cases. Three radiologists independently assigned the PI-RADS v2 score for each case. The missed lesions were further categorized as suspicious or invisible by consensus. The clinical characteristics, PI-RADS v2 scores, and histopathologic features were thereby obtained.
Thirty seven (62.7%) of the 59 study cases had a detected prostate cancer and 22 (37.3%) as having missed cancer. Seventeen (77.3%) of the 22 missed patients had a clinically significant lesion. The missed cancer cases had a smaller tumour volume, and higher ADC ratio than the detected cancer cases. Fourteen (63.6%) of the missed lesions were not visible on MRI, even though 71.4% of these cancers were clinically significant. Invisible but clinically significant cancers had a tumour volume below 1 cm in 70% of cases.
A negative MRI result does not rule out the current PI-RADS v2 definition of a clinically significant prostate cancer as these tumours can be missed if their volume is below 1 cm.
确定经活检前 MRI 及后续磁共振-超声（US）融合活检漏诊前列腺癌的临床和组织病理学特征及其前列腺影像报告和数据系统（PI-RADS）第 2 版（PI-RADS v2）评分。
我们分析了 59 例在接受 3-T MRI 检查后行 MRI-US 融合活检及后续根治性前列腺切除术的前列腺癌患者。最初由一名放射科医生对这些病例进行了分析，以将靶病变与病理证实的病变相关联。将患者分为检出前列腺癌和漏诊前列腺癌病例。3 名放射科医生独立为每个病例分配 PI-RADS v2 评分。通过共识将漏诊病变进一步分为可疑病变或不可见病变。获得了临床特征、PI-RADS v2 评分和组织病理学特征。
59 例研究病例中，37 例（62.7%）为检出前列腺癌，22 例（37.3%）为漏诊前列腺癌。22 例漏诊患者中有 17 例（77.3%）为临床显著病变。漏诊癌症的肿瘤体积较小，ADC 比值较高。14 例（63.6%）漏诊病变在 MRI 上不可见，尽管其中 71.4%的癌症为临床显著病变。不可见但临床显著的癌症中，70%的肿瘤体积小于 1cm。
阴性 MRI 结果不能排除当前 PI-RADS v2 定义的临床显著前列腺癌，因为如果肿瘤体积小于 1cm，则可能会漏诊这些肿瘤。
