活检前 IMPROD 双参数磁共振成像联合前列腺特异性抗原密度在前列腺癌诊断中的应用：一项外部验证研究。
Prebiopsy IMPROD Biparametric Magnetic Resonance Imaging Combined with Prostate-Specific Antigen Density in the Diagnosis of Prostate Cancer: An External Validation Study.
机构信息
Department of Urology, University of Turku and Turku University Hospital, Turku, Finland; Department of Surgery, Satakunta Central Hospital, Pori, Finland.
Department of Diagnostic Radiology, University of Turku, Turku, Finland; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland.
出版信息
Eur Urol Oncol. 2020 Oct;3(5):648-656. doi: 10.1016/j.euo.2019.08.008. Epub 2019 Sep 6.
BACKGROUND
Biparametric magnetic resonance imaging (bpMRI) combined with prostate-specific antigen density (PSAd) may be an effective strategy for selecting men for prostate biopsy. It has been shown that performing biopsy only for men with bpMRI Likert scores of 4-5 or PSAd ≥0.15 ng/ml/cm is the most efficient strategy.
OBJECTIVE
To externally validate previously published biopsy strategies using two prospective bpMRI trial cohorts.
DESIGN, SETTING, AND PARTICIPANTS: After IMPROD bpMRI, 499 men had systematic transrectal prostate biopsies and men with IMPROD bpMRI Likert scores of 3-5 had an additional two to four targeted biopsies.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Various IMPROD bpMRI Likert score and PSAd thresholds were assessed using detection rates for significant prostate cancer (sPCa; Gleason score ≥3 + 4), predictive values, and proportion of biopsies avoided. Net benefits and decision curve analyses (DCA) were compared with the aim of finding an optimal strategy for sPCa detection. Combined biopsies were used for reference.
RESULTS AND LIMITATIONS
The negative predictive value (NPV) for sPCa in IMPROD bpMRI Likert 3-5 and 4-5 score groups was 93% and 92%, respectively, while the corresponding positive predictive value (PPV) was 57% and 72%, respectively. In DCA, the optimal combination was IMPROD bpMRI Likert score 4-5 or Likert 3 with PSAd ≥0.20 ng/ml/cm, which had NPV of 93% and PPV of 67%. Using this combination, 35% of the study patients would have avoided biopsies and 13 sPCas (6%, 13/229, of all sPCas diagnosed) would have been missed.
CONCLUSIONS
IMPROD bpMRI demonstrated a good NPV for sPCa. PSAd improved the NPV mainly among men with equivocal suspicion on IMPROD bpMRI. However, the additional value of PSAd was marginal: the NPV and PPV for IMPROD bpMRI Likert 4-5 score group were 92% and 72%, respectively, while the corresponding values for the best combination strategy were 93% and 67%.
PATIENT SUMMARY
We investigated a rapid prostate magnetic resonance imaging protocol (IMPROD bpMRI) combined with prostate-specific antigen (PSA) density for detection of significant prostate cancer. Our results show that IMPROD bpMRI is a good diagnostic tool, but the additional value provided by PSA density is marginal.
背景
双参数磁共振成像（bpMRI）结合前列腺特异性抗原密度（PSAd）可能是一种选择接受前列腺活检男性的有效策略。已经表明，仅对 bpMRI 评分 4-5 或 PSAd≥0.15ng/ml/cm 的男性进行活检是最有效的策略。
目的
使用两个前瞻性 bpMRI 试验队列对外验证先前发表的活检策略。
设计、设置和参与者：在 IMPROD bpMRI 之后，499 名男性接受了系统的经直肠前列腺活检，而 IMPROD bpMRI 评分 3-5 的男性接受了另外两到四次靶向活检。
测量和统计分析
使用显著前列腺癌（sPCa；Gleason 评分≥3+4）的检出率、预测值和避免活检的比例评估各种 IMPROD bpMRI 评分和 PSAd 阈值。净效益和决策曲线分析（DCA）进行了比较，目的是为 sPCa 检测找到最佳策略。联合活检用于参考。
结果和局限性
IMPROD bpMRI 评分 3-5 和 4-5 组的 sPCa 阴性预测值（NPV）分别为 93%和 92%，而相应的阳性预测值（PPV）分别为 57%和 72%。在 DCA 中，最佳组合是 IMPROD bpMRI 评分 4-5 或评分 3 伴 PSAd≥0.20ng/ml/cm，NPV 为 93%，PPV 为 67%。使用这种组合，35%的研究患者可以避免活检，13 例 sPCa（6%，229 例所有 sPCa 中诊断出的 sPCa）会被遗漏。
结论
IMPROD bpMRI 对 sPCa 具有良好的 NPV。PSAd 主要提高了对 IMPROD bpMRI 结果不确定的男性的 NPV。然而，PSAd 的附加价值是微不足道的：IMPROD bpMRI 评分 4-5 组的 NPV 和 PPV 分别为 92%和 72%，而最佳组合策略的相应值分别为 93%和 67%。
患者总结
我们研究了一种快速前列腺磁共振成像方案（IMPROD bpMRI）结合前列腺特异性抗原（PSA）密度检测显著前列腺癌。我们的结果表明，IMPROD bpMRI 是一种很好的诊断工具，但 PSA 密度提供的附加价值微不足道。
Zotero 插件