University of Michigan Medical School, Ann Arbor, MI.
Department of Urology, Michigan Medicine, Ann Arbor, MI.
Urol Oncol. 2020 Jul;38(7):636.e13-636.e19. doi: 10.1016/j.urolonc.2020.01.011. Epub 2020 Feb 14.
Prostate cancer (CaP) staging traditionally includes computed tomography (CT) and technetium-99m bone scintigraphy (BS) for assessment of lymph node (LN) and bone metastases, respectively. In recent years, multiparametric magnetic resonance imaging (mpMRI) has been used in diagnostic assessment of CaP. We sought to compare the accuracy of mpMRI to CT and BS for pretreatment staging.
Using the Michigan Urological Surgery Improvement Collaborative registry, we identified men undergoing pretreatment mpMRI in addition to CT and/or BS in 2012 to 2018. Imaging reports were classified as positive, negative, or equivocal for detection of LN and bone metastases. A best value comparator (BVC) was used to adjudicate metastatic status in the absence of pathologic data. mpMRI accuracy was calculated using pessimistic (equivocal=positive) and optimistic (equivocal = negative) interpretations. We compared the diagnostic performance of mpMRI, CT, and BS in detecting metastases.
In total, 364 men underwent CT and mpMRI, and 646 underwent BS and mpMRI. Based on the BVC, 52 men (14%) harbored LN metastases and 38 (5.9%) harbored bone metastases. Sensitivity of mpMRI for LN metastases was significantly higher than CT (65-73% vs 38%, P < 0.005), and specificity of mpMRI and CT were 97% to 99% and 99% (P = 0.2-0.4), respectively. For bone metastases, BS sensitivity was 68% as compared to 42% to 71% (P = 0.02-0.83) for mpMRI. Specificity for bone metastases was 95% to 99% across all modalities.
Using statewide data, mpMRI appears superior to CT and comparable to BS for detection of LN and bone metastases, respectively. Pretreatment mpMRI may obviate the need for additional staging imaging.
前列腺癌（CaP）分期传统上包括计算机断层扫描（CT）和锝 99m 骨闪烁扫描（BS），分别用于评估淋巴结（LN）和骨转移。近年来，多参数磁共振成像（mpMRI）已用于 CaP 的诊断评估。我们旨在比较 mpMRI 对 CT 和 BS 用于预处理分期的准确性。
我们使用密歇根州泌尿外科手术改进协作注册处，确定了 2012 年至 2018 年间接受预处理 mpMRI 检查外加 CT 和/或 BS 检查的男性患者。影像学报告根据 LN 和骨转移的检测结果分为阳性、阴性或不确定。在缺乏病理数据的情况下，使用最佳值比较器（BVC）来判断转移状态。使用悲观（不确定=阳性）和乐观（不确定=阴性）解释计算 mpMRI 的准确性。我们比较了 mpMRI、CT 和 BS 在检测转移方面的诊断性能。
共有 364 名男性接受了 CT 和 mpMRI 检查，646 名男性接受了 BS 和 mpMRI 检查。根据 BVC，52 名男性（14%）存在 LN 转移，38 名男性（5.9%）存在骨转移。mpMRI 对 LN 转移的敏感性明显高于 CT（65-73%对 38%，P < 0.005），而 mpMRI 和 CT 的特异性分别为 97%至 99%和 99%（P=0.2-0.4）。对于骨转移，BS 的敏感性为 68%，而 mpMRI 的敏感性为 42%至 71%（P=0.02-0.83）。所有检测方法的骨转移特异性均为 95%至 99%。
使用全州范围的数据，mpMRI 似乎优于 CT，且在分别检测 LN 和骨转移方面与 BS 相当。预处理 mpMRI 可能可以避免额外的分期成像。
