前列腺外肿瘤侵犯：根治性前列腺切除术前多参数 MRI 标准与术后组织病理学相关性比较。
Extraprostatic Tumor Extension: Comparison of Preoperative Multiparametric MRI Criteria and Histopathologic Correlation after Radical Prostatectomy.
机构信息
From the Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
出版信息
Radiology. 2020 Jul;296(1):87-95. doi: 10.1148/radiol.2020192133. Epub 2020 May 5.
Background There are no standardized and well-validated criteria for assessing the risk of extraprostatic extension (EPE) of prostate cancer at preoperative multiparametric MRI. Purpose To compare diagnostic performance, intra- and interreader agreement, and correlations of MRI-based criteria for assessment of EPE after radical prostatectomy, including EPE grade, European Society of Urogenital Radiology (ESUR) score, Likert scale, and capsular contact length (CCL). Materials and Methods This retrospective study included consecutive men who underwent MRI and radical prostatectomy between July 2016 and March 2017. Two genitourinary radiologists independently estimated the probability of EPE by using four MRI-based scoring methods. The diagnostic accuracies and intra- and interobserver agreement were evaluated with area under the receiver operating characteristic curve (AUC) and κ statistics, respectively. Correlations between MRI-based score and histologic extent of EPE were analyzed by using the Spearman correlation coefficient (ρ). Results A total of 301 men (mean age ± standard deviation, 65 years ± 7) were evaluated. A total of 129 (42.9%) men had EPE. The AUC ranges of EPE grade, ESUR score, Likert scale, and CCL for assessment of EPE were 0.77-0.81, 0.79-0.81, 0.78-0.79, and 0.78-0.85, respectively, for the two readers. The Likert scale showed lower sensitivity (68.2% [88 of 129] for reader 1, 72.1% [93 of 129] for reader 2) than did EPE grade (77.5% [100 of 129] for reader 1, 79.8% [103 of 129] for reader 2; ≤ .04). Intra- and interreader agreement were substantial (κ range, 0.61-0.74) for the four methods, with ESUR score showing the lowest values (κ = 0.61 and κ = 0.63, respectively). EPE grade showed highest correlation with histologic extent of EPE (ρ = 0.53 and ρ = 0.55 for circumferential length; ρ = 0.42 and ρ = 0.55 for radial length for readers 1 and 2, respectively; < .001). Conclusion Extraprostatic extension (EPE) grade, European Society of Urogenital Radiology score, Likert scale, and capsular contact length showed good overall diagnostic performance; however, the EPE grade resulted in more reliable performance and had the highest correlation with histologic EPE extent. © RSNA, 2020 See also the editorial by Padhani and Petralia in this issue.
背景 目前尚无用于评估前列腺癌术前多参数 MRI 中前列腺外延伸（EPE）风险的标准化和充分验证的标准。
目的 比较基于 MRI 的 EPE 评估标准（包括 EPE 分级、欧洲泌尿生殖放射学会 [ESUR] 评分、Likert 量表和包膜接触长度 [CCL]）在评估经根治性前列腺切除术后 EPE 中的诊断性能、观察者内和观察者间一致性以及相关性。
材料与方法 本回顾性研究纳入了 2016 年 7 月至 2017 年 3 月间行 MRI 和根治性前列腺切除术的连续男性患者。两名泌尿生殖系统放射科医生分别使用 4 种基于 MRI 的评分方法来估计 EPE 的可能性。使用受试者工作特征曲线（receiver operating characteristic curve，ROC）下面积（area under the receiver operating characteristic curve，AUC）和 κ 统计量评估诊断准确性和观察者内和观察者间一致性。使用 Spearman 相关系数（Spearman correlation coefficient，ρ）分析基于 MRI 的评分与 EPE 组织学程度之间的相关性。
结果 共评估了 301 名男性（平均年龄±标准差，65 岁±7 岁）。共有 129 名（42.9%）男性存在 EPE。两名观察者评估 EPE 分级、ESUR 评分、Likert 量表和 CCL 的 AUC 范围分别为 0.77-0.81、0.79-0.81、0.78-0.79 和 0.78-0.85。Likert 量表的敏感性（观察者 1：68.2%[129 例中的 88 例]，观察者 2：72.1%[129 例中的 93 例]）低于 EPE 分级（观察者 1：77.5%[129 例中的 100 例]，观察者 2：79.8%[129 例中的 103 例]；≤.04）。四种方法的观察者内和观察者间一致性均为中等（κ 范围，0.61-0.74），其中 ESUR 评分的一致性最低（κ=0.61 和 κ=0.63）。EPE 分级与 EPE 组织学程度相关性最高（观察者 1 和观察者 2 的周长长度分别为 ρ=0.53 和 ρ=0.55，径长分别为 ρ=0.42 和 ρ=0.55；<.001）。
结论 EPE 分级、ESUR 评分、Likert 量表和包膜接触长度的总体诊断性能良好；然而，EPE 分级的表现更可靠，与组织学 EPE 程度相关性最高。
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