Trent Graham P, Ye Nancy, Chopra Jasleen, Chen Rong, Wong-You-Cheong Jade, Naslund Michael, Siddiqui Mohummad M, Wnorowski Amelia
University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201, United States of America.
University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, 22 South Greene Street, Baltimore, MD 21201, United States of America.
Clin Imaging. 2020 Aug;64:29-34. doi: 10.1016/j.clinimag.2020.03.004. Epub 2020 Mar 13.
To validate the performance of PI-RADS v2 for detection of clinically significant prostate cancer (csPca, Gleason ≥7) within the context of a new fusion biopsy program.
Patients with a PI-RADS v2 assessment category assigned on pre-biopsy mpMRI between March 2015 and November 2017 were identified. Diagnostic performance of PI-RADS v2 was calculated using fusion biopsy results as reference standard using receiver operating characteristic curve analysis. Patient and lesion characteristics were analyzed with one-way ANOVA and Wilcoxon rank sum test.
Of 83 patients with 175 lesions, 115/175 (65.7%) were benign, 21/175 (12%) were Gleason 6, and 39/175 (22.3%) were Gleason ≥7. csPCa rates were 0% (0/5) for PI-RADS 1, 7.4% (2/27) for PI-RADS 2, 5.8% (3/52) for PI-RADS 3, 31.2% (24/77) for PI-RADS 4, and 71.4% (10/14) for PI-RADS 5 (p < 0.0001). For prediction of csPCa, patient-level AUC was 0.68 and lesion-level AUC was 0.77. Biopsy threshold of PI-RADS ≥3 was 92.6% sensitive and 22.1% specific. A threshold of PI-RADS ≥4 was 87.2% sensitive and 58.1% specific. Rate of csPca detection on concurrent standard 12 core biopsy only was 6.7%.
PI-RADS v2 assessment categories assigned prior to biopsy predict pathologic outcome reasonably well in a new prostate fusion biopsy program. Biopsy threshold of PI-RADS ≥3 is highly sensitive. A threshold of ≥4 increases specificity but misses some csPCa.
在一项新的融合活检计划背景下，验证PI-RADS v2检测临床显著前列腺癌（csPca，Gleason评分≥7）的性能。
确定2015年3月至2017年11月间在活检前mpMRI上被赋予PI-RADS v2评估类别的患者。以融合活检结果作为参考标准，采用受试者操作特征曲线分析计算PI-RADS v2的诊断性能。采用单因素方差分析和Wilcoxon秩和检验分析患者和病变特征。
83例患者共175个病变，其中115/175（65.7%）为良性，21/175（12%）为Gleason 6级，39/175（22.3%）为Gleason≥7级。PI-RADS 1级的csPCa率为0%（0/5），PI-RADS 2级为7.4%（2/27），PI-RADS 3级为5.8%（3/52），PI-RADS 4级为31.2%（24/77），PI-RADS 5级为71.4%（10/14）（p<0.0001）。对于csPCa的预测，患者水平的AUC为0.68，病变水平的AUC为0.77。PI-RADS≥3的活检阈值敏感性为92.6%，特异性为22.1%。PI-RADS≥4的阈值敏感性为87.2%，特异性为58.1%。仅同时进行标准12针活检时csPca的检出率为6.7%。
在新的前列腺融合活检计划中，活检前赋予的PI-RADS v2评估类别对病理结果的预测相当不错。PI-RADS≥3的活检阈值具有高度敏感性。≥4的阈值可提高特异性，但会遗漏一些csPCa。
