根治性前列腺切除术前行腹盆腔 CT 和多参数 MR 成像检测淋巴结转移的局限性。

Limitations of abdominopelvic CT and multiparametric MR imaging for detection of lymph node metastases prior to radical prostatectomy.

机构信息

Spectrum Health, 145 Michigan Street NE, Grand Rapids, MI, USA.

Michigan State University College of Human Medicine, Grand Rapids, MI, USA.

出版信息

World J Urol. 2021 Mar;39(3):779-785. doi: 10.1007/s00345-020-03227-7. Epub 2020 May 2.

DOI:10.1007/s00345-020-03227-7

PMID:32361876

Abstract

PURPOSE

To investigate the performance of pre-surgery CT and multiparametric MRI (mpMRI) to identify lymph node (LN) metastases in the Michigan Urological Surgery Improvement Collaborative (MUSIC). Abdominopelvic CT and mpMRI are commonly used for intermediate- and high-risk prostate cancer (PCa) staging.

METHODS

Retrospective analysis of the MUSIC registry identified patients undergoing robot-assisted radical prostatectomy (RP) between 3/2012 and 7/2018. Patients were classified according to pre-surgery imaging modality. Primary outcomes were operating characteristics of CT and mpMRI for detection of pathologic LN involvement (pN1).

RESULTS

A total of 10,250 patients underwent RP and 3924 patients (38.3%) underwent CT and/or mpMRI prior to surgery. Suspicion for LN involvement was identified on 2.3% CT and 1.9% mpMRI. Overall, 391 patients were pN1(3.8%), including 0.1% low-, 2.1% intermediate-, and 10.9% high-risk PCa patients. Of 235 pN1 patients that underwent CT prior, far more had negative (91.1%) than positive (8.9%) findings, yielding sensitivity: 8.9%, specificity: 98.3%, negative predictive value (NPV): 92.1%, and positive predictive value (PPV): 32.3% for CT with regard to LN metastases. Similarly, more patients with pN1 disease had negative mpMRI (81.0%) then suspicious or indeterminate MRI (19.0%), yielding sensitivity: 19.0%, specificity: 97.3%, NPV: 95.9%, and PPV: 26.7%.

CONCLUSIONS

Abdominopelvic CT and mpMRI have clear limitations in identifying LN metastases. Additional clinicopathologic features should be considered when making management decisions, as 2.1% and 10.9% with intermediate-and high-risk cancer had metastatic LNs. The majority of pN1 patients had a negative CT or a negative/indeterminate mpMRI prior to RP. Pelvic LN dissection should be performed in RP patients with intermediate- or high-risk PCa, independent of preoperative imaging results.

摘要

目的

在密歇根泌尿外科手术改进协作组（MUSIC）中，研究术前 CT 和多参数 MRI（mpMRI）在识别淋巴结（LN）转移中的性能。腹部盆腔 CT 和 mpMRI 常用于中高危前列腺癌（PCa）分期。

方法

对 MUSIC 登记处进行回顾性分析，确定 2012 年 3 月至 2018 年 7 月期间接受机器人辅助根治性前列腺切除术（RP）的患者。根据术前影像学方式对患者进行分类。主要结局为 CT 和 mpMRI 检测病理性 LN 受累（pN1）的操作特征。

结果

共 10250 例患者接受 RP，3924 例（38.3%）患者在术前接受 CT 和/或 mpMRI 检查。2.3%的 CT 和 1.9%的 mpMRI 检查怀疑有 LN 受累。总体而言，391 例患者为 pN1（3.8%），包括 0.1%低危、2.1%中危和 10.9%高危 PCa 患者。在接受术前 CT 检查的 235 例 pN1 患者中，更多的患者 CT 检查结果为阴性（91.1%）而非阳性（8.9%），CT 检测 LN 转移的敏感性为 8.9%，特异性为 98.3%，阴性预测值（NPV）为 92.1%，阳性预测值（PPV）为 32.3%。同样，更多的 pN1 疾病患者的 mpMRI 检查结果为阴性（81.0%）而非可疑或不确定 MRI（19.0%），mpMRI 检测 LN 转移的敏感性为 19.0%，特异性为 97.3%，NPV 为 95.9%，PPV 为 26.7%。

结论

腹部盆腔 CT 和 mpMRI 在识别 LN 转移方面存在明显局限性。在做出治疗决策时应考虑其他临床病理特征，因为 2.1%和 10.9%的中高危癌症患者存在转移性 LN。大多数 pN1 患者在接受 RP 之前的 CT 检查为阴性或 mpMRI 检查为阴性/不确定。中高危 PCa 患者应在 RP 时行盆腔 LN 清扫，而不依赖术前影像学结果。