Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
BJU Int. 2020 Jan;125(1):49-55. doi: 10.1111/bju.14916. Epub 2019 Nov 1.
To compare the clinical validity and utility of Likert assessment and the Prostate Imaging Reporting and Data System (PI-RADS) v2 in the detection of clinically significant and insignificant prostate cancer.
A total of 489 pre-biopsy multiparametric magnetic resonance imaging (mpMRI) scans in consecutive patients were subject to prospective paired reporting using both Likert and PI-RADS v2 by expert uro-radiologists. Patients were offered biopsy for any Likert or PI-RADS score ≥4 or a score of 3 with PSA density ≥0.12 ng/mL/mL. Utility was evaluated in terms of proportion biopsied, and proportion of clinically significant and insignificant cancer detected (both overall and on a 'per score' basis). In those patients biopsied, the overall accuracy of each system was assessed by calculating total and partial area under the receiver-operating characteristic (ROC) curves. The primary threshold of significance was Gleason ≥3 + 4. Secondary thresholds of Gleason ≥4 + 3, Ahmed/UCL1 (Gleason ≥4 + 3 or maximum cancer core length [CCL] ≥6 or total CCL≥6) and Ahmed/UCL2 (Gleason ≥3 + 4 or maximum CCL ≥4 or total CCL ≥6) were also used.
The median (interquartile range [IQR]) age was 66 (60-72) years and the median (IQR) prostate-specific antigen level was 7 (5-10) ng/mL. A similar proportion of men met the biopsy threshold and underwent biopsy in both groups (83.8% [Likert] vs 84.8% [PI-RADS v2]; P = 0.704). The Likert system predicted more clinically significant cancers than PI-RADS across all disease thresholds. Rates of insignificant cancers were comparable in each group. ROC analysis of biopsied patients showed that, although both scoring systems performed well as predictors of significant cancer, Likert scoring was superior to PI-RADS v2, exhibiting higher total and partial areas under the ROC curve.
Both scoring systems demonstrated good diagnostic performance, with similar rates of decision to biopsy. Overall, Likert was superior by all definitions of clinically significant prostate cancer. It has the advantages of being flexible, intuitive and allowing inclusion of clinical data. However, its use should only be considered once radiologists have developed sufficient experience in reporting prostate mpMRI.
比较 Likert 评估和前列腺影像报告和数据系统（PI-RADS）v2 在检测临床显著和不显著前列腺癌中的临床有效性和实用性。
对连续患者的 489 例前列腺多参数磁共振成像（mpMRI）扫描进行前瞻性配对报告，由经验丰富的泌尿放射科医生使用 Likert 和 PI-RADS v2 进行评分。对任何 Likert 或 PI-RADS 评分≥4 分或评分 3 分且 PSA 密度≥0.12ng/mL/ml 的患者进行活检。实用性通过活检的比例和检测到的临床显著和不显著癌症的比例（总体和按“每分”计算）进行评估。在接受活检的患者中，通过计算受试者工作特征（ROC）曲线的总和部分面积来评估每个系统的整体准确性。主要显著性阈值为 Gleason≥3+4。次要阈值为 Gleason≥4+3、Ahmed/UCL1（Gleason≥4+3 或最大癌核长度[CCL]≥6 或总 CCL≥6）和 Ahmed/UCL2（Gleason≥3+4 或最大 CCL≥4 或总 CCL≥6）。
中位（四分位距[IQR]）年龄为 66（60-72）岁，中位（IQR）前列腺特异性抗原水平为 7（5-10）ng/ml。两组中符合活检阈值并接受活检的男性比例相似（83.8%[Likert]与 84.8%[PI-RADS v2]；P=0.704）。与 PI-RADS v2 相比，Likert 系统在所有疾病阈值下预测的临床显著癌症更多。在每组中，无显著癌症的发生率相似。对接受活检的患者进行 ROC 分析表明，尽管两种评分系统作为预测显著癌症的指标均表现良好，但 Likert 评分优于 PI-RADS v2，总 ROC 曲线下面积和部分 ROC 曲线下面积更高。
两种评分系统均表现出良好的诊断性能，活检决策率相似。总体而言，Likert 系统优于所有定义的临床显著前列腺癌。它具有灵活、直观的优点，并允许纳入临床数据。然而，只有在放射科医生在报告前列腺 mpMRI 方面积累了足够的经验后，才能考虑使用它。
