Postgraduate School in Radiodiagnostics, University of Milan.
Postgraduate School in Radiodiagnostics, University of Milan.
Clin Genitourin Cancer. 2021 Dec;19(6):e335-e345. doi: 10.1016/j.clgc.2021.04.004. Epub 2021 Apr 20.
To investigate the use of apparent diffusion coefficient (ADC) values and other MRI features for predicting positive surgical margins (PSMs) in patients undergoing radical prostatectomy.
We retrospectively identified 400 consecutive patients who underwent surgery for prostate cancer between January 2015 and June 2016. ADC values of the index lesion and other preoperative magnetic resonance imaging features, including tumor site, laterality, level, Prostate Imaging Reporting and Data System category, European Society of Urogenital Radiology extracapsular extension score, and prostate volume, were assessed. Univariate and multivariable logistic regression were performed. Performance in predicting the occurrence of PSMs was measured using the area under the curve (AUC). AUC differences were evaluated with the DeLong method. The Youden index was calculated to identify the ADC threshold to best discriminate patients with PSMs.
Of the 400 patients, 105 (26.2%) had PSMs after radical prostatectomy. ADC values, Prostate Imaging Reporting and Data System category, extracapsular extension score, tumor site, and laterality were significantly associated with PSMs (P < .001) in univariate analysis. The AUC of the predictive model based on ADC alone was 68.2% (95% confidence interval, 62.2-74.2%) and did not significantly differ from the best multivariable predictive model which combined laterality, and site with ADC to attain an AUC of 70.0% (95% confidence interval, 64.2-75.8%; DeLong P = .318). The ADC threshold that maximized the Youden index was 960.3 µm/s.
ADC values and preoperative magnetic resonance imaging features can help estimate the risk of PSMs after radical prostatectomy.
研究表观扩散系数（ADC）值和其他 MRI 特征在预测接受根治性前列腺切除术患者的阳性切缘（PSM）中的作用。
我们回顾性地确定了 400 例于 2015 年 1 月至 2016 年 6 月期间接受前列腺癌手术的连续患者。评估了指数病变的 ADC 值以及其他术前磁共振成像特征，包括肿瘤部位、侧别、水平、前列腺影像报告和数据系统（PI-RADS）分类、欧洲泌尿生殖放射学会（ESUR）包膜外延伸评分以及前列腺体积。进行了单变量和多变量逻辑回归。使用曲线下面积（AUC）来衡量预测 PSM 发生的性能。使用 DeLong 方法评估 AUC 差异。计算约登指数以确定 ADC 阈值以最佳区分 PSM 患者。
在 400 例患者中，105 例（26.2%）在根治性前列腺切除术后发生 PSM。在单变量分析中，ADC 值、PI-RADS 分类、包膜外延伸评分、肿瘤部位和侧别与 PSM 显著相关（P <.001）。基于 ADC 的预测模型的 AUC 为 68.2%（95%置信区间，62.2-74.2%），与结合侧别和部位与 ADC 的最佳多变量预测模型的 AUC （70.0%，95%置信区间，64.2-75.8%；DeLong P ＝.318）没有显著差异。最大化约登指数的 ADC 阈值为 960.3 µm/s。
ADC 值和术前磁共振成像特征有助于估计根治性前列腺切除术后 PSM 的风险。
