经会阴模板引导活检的前列腺多参数磁共振成像初始阅片与第二意见阅片的比较，联合 MRI-超声融合技术。

Comparison of initial and second opinion reads of multiparametric magnetic resonance imaging of the prostate for transperineal template-guided biopsies with MRI-Ultrasound fusion.

机构信息

Department of Urology, HELIOS Hospital, Bad Saarow, Germany; Brandenburg Medical School, BB, Germany.

Department of Radiology, Vivantes Klinikum Friedrichshain, Berlin, Germany.

出版信息

Urol Oncol. 2021 Nov;39(11):781.e1-781.e7. doi: 10.1016/j.urolonc.2021.01.008. Epub 2021 Feb 7.

DOI:10.1016/j.urolonc.2021.01.008

PMID:33563540

Abstract

PURPOSE

To investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists for the detection of significant cancer in transperineal fusion prostate biopsy.

METHODS

The evaluated data included age, PSA (ng/ml), PSA density, Gleason score, digital rectal examination (DRE), prostate volume of 149 patients. Twenty-seven patients (18%) had no previous prostate biopsy, 114 patients (77%) had a previous negative biopsy, and 8 patients (5%) were on active surveillance. Using PI-RADS v2 scores for mpMRI a second report was performed by a specialist uroradiologist. In all cases a subsequent transperineal biopsy was performed with at least 2 cores per target and additional background systemic cores. Initial and second-opinion radiology reports were evaluated for detection of any cancer and Gleason score (GS) 7-10 cancer, including positive predictive value and negative (NPV) and compared by Fisher's exact test.

RESULTS

At transperineal biopsy, 51 % (76/149) of patients had a GS 6-10 prostate cancer (PCa), 27 % (40/149) of patients had a GS 3 + 3 PCa and 12 % (18/149) a GS 3 + 4 and 12 % (18/149) had a GS ≥4 + 3 PCa. Agreement between initial and second-opinion reads was observed in 57.7% (86/149; kappa value = 0.32). The detection of clinically significant cancers with second-opinion reads was significantly higher (0.61; 17/28) compared to initial reads (0.35; 17/49); P = 0.034.

CONCLUSIONS

Second reading of prostate mpMRIs by subspecialised uroradiologists significantly improved the positive predictive value for detection of clinically significant prostate cancer and showed a trend towards improved NPV for MRI-negative cases where biopsy could be safely avoided. Urologists should be aware that the experience of the reporter will affect the report when making decisions if and how to obtain biopsies. Reporter experience may help to reduce overcalling and avoid over-targeting of lesions.

摘要

目的

探讨由泌尿科专家对经会阴融合前列腺活检进行多参数前列腺磁共振成像（mpMRI）的二次评估对检出经会阴前列腺活检中显著癌的价值。

方法

评估数据包括年龄、PSA（ng/ml）、PSA 密度、Gleason 评分、直肠指检（DRE）和 149 例患者的前列腺体积。27 例（18%）患者无既往前列腺活检史，114 例（77%）患者既往活检阴性，8 例（5%）患者处于主动监测中。使用 mpMRI 的 PI-RADS v2 评分，由一名泌尿科专家进行二次报告。在所有情况下，均进行经会阴前列腺活检，每个目标部位至少进行 2 针靶向活检和额外的系统性背景活检。比较初始和二次阅片报告对任何癌症和 Gleason 评分（GS）7-10 癌症的检出情况，包括阳性预测值和阴性预测值（NPV），并采用 Fisher 精确检验进行比较。

结果

经会阴前列腺活检中，51%（76/149）的患者存在 GS 6-10 前列腺癌（PCa），27%（40/149）的患者存在 GS 3+3 PCa，12%（18/149）的患者存在 GS 3+4，12%（18/149）的患者存在 GS≥4+3 PCa。初始阅片和二次阅片之间的一致性观察到 57.7%（86/149；kappa 值=0.32）。与初始阅片相比，二次阅片对临床显著癌症的检出率显著更高（0.61；17/28），与初始阅片（0.35；17/49）相比，P=0.034。

结论

由泌尿科专家对前列腺 mpMRI 进行二次阅读显著提高了检出临床显著前列腺癌的阳性预测值，并且显示出对 MRI 阴性病例的 NPV 有改善趋势，这些病例可以安全避免活检。泌尿科医生应该意识到，报告者的经验会影响在是否进行活检以及如何进行活检的决策中。报告者的经验可以帮助减少过度诊断和避免对病变的过度靶向。