Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
Eur Radiol. 2020 Jan;30(1):26-37. doi: 10.1007/s00330-019-06340-3. Epub 2019 Aug 5.
To validate how established markers of extraprostatic extension (EPE) are applied to anterior prostate cancers (APCs), and to investigate other novel markers if available.
Among 614 histopathologically confirmed APCs from 2011 to 2016, 221 lesions with PiRADS (verion 2) scores ≥ 4 on 3-T multi-parametric MRI were analyzed retrospectively. Two radiologists independently assessed capsular morphology qualitatively with 5-point scale (normal, thinning, bulging, loss, extracapsular disease), and capsule contact length (arc), tumor dimension, and their ratio (arc-dimension ratio) quantitatively. Reproducibility in measurement was assessed with κ and intra-class correlation coefficients (ICCs). Logistic regression analysis was done to find meaningful indicators of EPE. Diagnostic performance of markers was compared to one another with generalized linear model and multi-reader multi-case ROC analysis.
Reproducibility was moderate to substantial (κ 0.45-0.73) for qualitative, and moderate to almost perfect (ICC 0.50-0.87) for quantitative features of EPE. Capsular morphology (odds ratio [OR] 1.818), capsule contact length (OR 1.115), tumor dimension (OR 1.035), and arc-dimension ratio (OR 1.846) were independently associated with EPE (p ≤ 0.019). Capsular bulging and capsule contact length of 10 mm as thresholds of EPE demonstrated sensitivity/specificity of 0.58/0.85 and 0.77/0.68, respectively. Capsule contact length yielded greatest AUC (0.784), followed by capsular morphology (0.778), arc-dimension ratio (0.749), and tumor dimension (0.741). Diagnostic performance of capsular morphology, capsule contact length, and arc-dimension ratio was comparable in predicting EPE.
Existing markers of EPE applicable regardless of locations of tumors apply similarly to APCs. Arc-dimension ratio may be a novel marker of EPE of APCs.
• Existing imaging markers of extraprostatic extension (EPE) which have been applied regardless of locations of tumors are reflected similarly to anterior prostate cancers (APCs). • Measuring tumor dimension without capsular assessment may result in insufficient pre-operative prediction of EPE of APCs. • Arc-dimension ratio (capsule contact length divided by tumor dimension) exhibited highest OR and comparable performance to existing features in predicting EPE of APCs.
验证已确立的前列腺外扩展（EPE）标志物在前列腺前癌（APC）中的应用，并探讨其他可能的新标志物。
对 2011 年至 2016 年间的 614 例经组织病理学证实的 APC 患者中，221 例在 3-T 多参数 MRI 上 PiRADS（版本 2）评分≥4 的病变进行回顾性分析。两位放射科医生使用 5 分制（正常、变薄、隆起、丢失、包膜外疾病）对包膜形态进行定性评估，并使用定量方法测量包膜接触长度（弧长）、肿瘤尺寸及其比值（弧-尺寸比）。采用κ和组内相关系数（ICC）评估测量的可重复性。进行逻辑回归分析以找到 EPE 的有意义指标。使用广义线性模型和多读者多病例 ROC 分析比较标志物之间的诊断性能。
包膜形态（优势比[OR]1.818）、包膜接触长度（OR 1.115）、肿瘤尺寸（OR 1.035）和弧-尺寸比（OR 1.846）与 EPE 独立相关（p≤0.019）。包膜隆起和包膜接触长度为 10mm 作为 EPE 的阈值，其敏感性/特异性分别为 0.58/0.85 和 0.77/0.68。包膜接触长度的 AUC 最大（0.784），其次是包膜形态（0.778）、弧-尺寸比（0.749）和肿瘤尺寸（0.741）。包膜形态、包膜接触长度和弧-尺寸比在预测 EPE 方面的诊断性能相当。
适用于肿瘤位置的 EPE 现有标志物同样适用于 APC。弧-尺寸比可能是 APC 包膜外扩展的新标志物。
适用于肿瘤位置的现有前列腺外扩展（EPE）成像标志物在前列腺前癌（APC）中也有类似的反映。
不评估包膜而仅测量肿瘤尺寸可能会导致 APC 包膜外扩展的术前预测不足。
弧-尺寸比（包膜接触长度除以肿瘤尺寸）表现出最高的优势比（OR），在预测 APC 的 EPE 方面与现有特征的表现相当。
