李克特量表与PI-RADS v2版MRI评分系统在检测临床显著性前列腺癌方面的比较。
Comparison of Likert and PI-RADS version 2 MRI scoring systems for the detection of clinically significant prostate cancer.
作者信息
Zawaideh Jeries P, Sala Evis, Pantelidou Maria, Shaida Nadeem, Koo Brendan, Caglic Iztok, Warren Anne Y, Carmisciano Luca, Saeb-Parsy Kasra, Gnanapragasam Vincent J, Kastner Christof, Barrett Tristan
机构信息
Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
出版信息
Br J Radiol. 2020 Aug;93(1112):20200298. doi: 10.1259/bjr.20200298. Epub 2020 Jun 11.
OBJECTIVE
To compare the performance of Likert and Prostate Imaging-Reporting and Data System (PI-RADS) multiparametric (mp) MRI scoring systems for detecting clinically significant prostate cancer (csPCa).
METHODS
199 biopsy-naïve males undergoing prostate mpMRI were prospectively scored with Likert and PI-RADS systems by four experienced radiologists. A binary cut-off (threshold score ≥3) was used to analyze histological results by three groups: negative, insignificant disease (Gleason 3 + 3; iPCa), and csPCa (Gleason ≥3 +4). Lesion-level results and prostate zonal location were also compared.
RESULTS
129/199 (64.8%) males underwent biopsy, 96 with Likert or PI-RADS score ≥3, and 21 with negative MRI. A further 12 patients were biopsied during follow-up (mean 507 days). Prostate cancer was diagnosed in 87/199 (43.7%) patients, 65 with (33.6%) csPCa. 30/92 (32.6%) patients with negative MRI were biopsied, with an NPV of 83.3% for cancer and 86.7% for csPCa. Likert and PI-RADS score differences were observed in 92 patients (46.2%), but only for 16 patients (8%) at threshold score ≥3. Likert scoring had higher specificity than PI-RADS (0.77 0.66), higher area under the curve (0.92 0.87, = 0.002) and higher PPV (0.66 0.58); NPV and sensitivity were the same. Likert had more five score results (58%) compared to PI-RADS (36%), but with similar csCPa detection (81.0 and 80.6% respectively). Likert demonstrated lower proportion of false positive in the predominately AFMS-involving lesions.
CONCLUSION
Likert and PI-RADS systems both demonstrate high cancer detection rates. Likert scoring had a higher AUC with moderately higher specificity and lower positive call rate and could potentially help to reduce the number of unnecessary biopsies performed.
ADVANCES IN KNOWLEDGE
This paper illustrates that the Likert scoring system has potential to help urologists reduce the number of prostate biopsies performed.
目的
比较李克特量表（Likert）和前列腺影像报告和数据系统（PI-RADS）多参数（mp）MRI评分系统在检测临床显著性前列腺癌（csPCa）方面的表现。
方法
199例未接受过活检的男性接受了前列腺mpMRI检查，由四位经验丰富的放射科医生分别使用李克特量表和PI-RADS系统进行前瞻性评分。采用二元截断值（阈值评分≥3）将组织学结果分为三组进行分析：阴性、非显著性疾病（Gleason 3+3；iPCa）和csPCa（Gleason≥3+4）。还比较了病变水平结果和前列腺分区位置。
结果
199例男性中有129例（64.8%）接受了活检，其中96例李克特量表或PI-RADS评分≥3，21例MRI结果为阴性。另外12例患者在随访期间（平均507天）接受了活检。199例患者中有87例（43.7%）被诊断为前列腺癌，其中65例（33.6%）为csPCa。92例MRI结果为阴性的患者中有30例（32.6%）接受了活检，癌症的阴性预测值为83.3%，csPCa的阴性预测值为86.7%。92例患者（46.2%）观察到李克特量表和PI-RADS评分存在差异，但在阈值评分≥3时仅16例患者（8%）存在差异。李克特量表评分的特异性高于PI-RADS（0.77对0.66），曲线下面积更大（0.92对0.87，P=0.002），阳性预测值更高（0.66对0.58）；阴性预测值和敏感性相同。与PI-RADS（36%）相比，李克特量表有更多的五分结果（58%），但csPCa检测率相似（分别为81.0%和80.6%）。在主要累及腺周基质的病变中，李克特量表显示假阳性比例较低。
结论
李克特量表和PI-RADS系统均显示出较高的癌症检测率。李克特量表评分具有更高的曲线下面积，特异性略高且阳性判定率较低，可能有助于减少不必要的活检数量。
知识进展
本文表明李克特量表评分系统有可能帮助泌尿科医生减少前列腺活检的数量。
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