Department of Medical Imaging, Royal Hobart Hospital, Hobart, Tasmania, Australia.
University of Tasmania, Hobart, Tasmania, Australia.
J Med Imaging Radiat Oncol. 2020 Jun;64(3):379-384. doi: 10.1111/1754-9485.13029. Epub 2020 Apr 3.
Multi-parametric magnetic resonance imaging of the prostate is crucial in detecting prostate cancer (CaP) and staging local disease. The Prostate Imaging Reporting and Data System (PIRADS) scoring system is used to assess and classify lesions and enables communication between clinicians and radiologists. This study aimed to assess the accuracy of PIRADSv2 in detecting CaP using histopathology specimens within our local service.
This retrospective study included 192 patients between September 2016 and May 2019. All had mpMRI prostate examinations prior to biopsy or prostatectomy. Lesions on MRI were assigned a PIRADS score and comparison made with histopathology results. Gleason score ≥7 was considered as clinically significant prostate cancer (csCaP). We calculated accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting all CaP and csCaP.
In the PIRADS 3 group, 32% were Gleason 6 and 32% were Gleason 7 lesions. In the PIRADS 4 group, 37% were Gleason 6 and 41% were Gleason ≥7. For PIRADS 5 lesions, 32% were Gleason 6 and 68% were Gleason ≥7. For all CaP, sensitivity was 84.7%, specificity 54.6%, PPV 82.3% and NPV 58.8%. For csCaP Gleason ≥7, PIRADS cut-off ≥3 had sensitivity, specificity, PPV and NPV of 95.7%, 39.3%, 47.5% and 94.1%, respectively, and cut-off ≥4 had sensitivity, specificity, PPV and NPV of 84.3%, 53.3%, 50.9% and 85.5%.
This study confirms PIRADS has high accuracy, sensitivity and NPV for detecting all CaP and csCaP. A high NPV may obviate need for biopsy in low-risk patients.
前列腺多参数磁共振成像对于检测前列腺癌（CaP）和局部疾病分期至关重要。前列腺影像报告和数据系统（PIRADS）评分系统用于评估和分类病变，并促进临床医生和放射科医生之间的沟通。本研究旨在评估 PIRADSv2 在我们当地服务中使用组织病理学标本检测 CaP 的准确性。
这是一项回顾性研究，纳入了 2016 年 9 月至 2019 年 5 月间的 192 名患者。所有患者均在前列腺活检或前列腺切除术前进行了 mpMRI 前列腺检查。MRI 上的病变被分配 PIRADS 评分，并与组织病理学结果进行比较。Gleason 评分≥7 被认为是临床显著前列腺癌（csCaP）。我们计算了检测所有 CaP 和 csCaP 的准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在 PIRADS 3 组中，32%的患者为 Gleason 6 级病变，32%的患者为 Gleason 7 级病变。在 PIRADS 4 组中，37%的患者为 Gleason 6 级病变，41%的患者为 Gleason≥7 级病变。对于 PIRADS 5 级病变，32%的患者为 Gleason 6 级病变，68%的患者为 Gleason≥7 级病变。对于所有 CaP，敏感性为 84.7%，特异性为 54.6%，PPV 为 82.3%，NPV 为 58.8%。对于 Gleason≥7 的 csCaP，PIRADS 截断值≥3 的敏感性、特异性、PPV 和 NPV 分别为 95.7%、39.3%、47.5%和 94.1%，截断值≥4 的敏感性、特异性、PPV 和 NPV 分别为 84.3%、53.3%、50.9%和 85.5%。
本研究证实 PIRADS 对检测所有 CaP 和 csCaP 具有较高的准确性、敏感性和 NPV。高 NPV 可能使低危患者免于活检。
