Krüger-Stokke Brage, Bertilsson Helena, Langørgen Sverre, Sjøbakk Torill Anita Eidhammer, Bathen Tone Frost, Selnæs Kirsten Margrete
Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Front Oncol. 2021 Oct 14;11:745657. doi: 10.3389/fonc.2021.745657. eCollection 2021.
This study aims to prospectively estimate the diagnostic performance of multiparametric prostate MRI (mpMRI) and compare the detection rates of prostate cancer using cognitive targeted transrectal ultrasound (TRUS) guided biopsies, targeted MR-guided in-bore biopsies (MRGB), or both methods combined in biopsy-naïve men.
The biopsy-naïve men referred for mpMRI (including T2-weighted, diffusion-weighted and dynamic contrast enhanced MRI) due to prostate cancer suspicion (elevated prostate-specific antigen or abnormal digital rectal examination) were eligible for inclusion. The images were scored according to Prostate Imaging Reporting and Data System (PI-RADS) v2, and men with PI-RADS 1-2 lesions were referred for routine systematic TRUS, while those with PI-RADS 3-5 lesions were randomized to MRGB or cognitive targeted TRUS. Men randomized to MRGB were referred to a secondary TRUS 2 weeks after MRGB. Gleason grade group ≥2 was defined as clinically significant prostate cancer. The performance of mpMRI was estimated using prostate cancer detected by any biopsy method as the reference test.
A total of 210 men were included. There was no suspicion of prostate cancer after mpMRI (PI-RADS 1-2) in 48% of the men. Among these, significant and insignificant prostate cancer was diagnosed in five and 11 men, respectively. Thirty-five men who scored as PI-RADS 1-2 did not undergo biopsy and were therefore excluded from the calculation of diagnostic accuracy. The overall sensitivity, specificity, negative predictive value, and positive predictive value of mpMRI for the detection of significant prostate cancer were 0.94, 0.63, 0.92, and 0.67, respectively. In patients with PI-RADS 3-5 lesions, the detection rates for significant prostate cancer were not significantly different between cognitive targeted TRUS (68.4%), MRGB (57.7%), and the combination of the two biopsy methods (64.4%). The median numbers of biopsy cores taken per patient undergoing systematic TRUS, cognitive targeted TRUS, and MRGB were 14 [8-16], 12 [6-17], and 2 [1-4] respectively.
mpMRI, in a cohort of biopsy-naïve men, has high negative predictive value, and our results support that it is safe to avoid biopsy after negative mpMRI. Furthermore, MRGB provides a similar diagnosis to the cognitive targeted TRUS but with fewer biopsies.
本研究旨在前瞻性评估多参数前列腺磁共振成像（mpMRI）的诊断性能，并比较在未经活检的男性中，使用认知靶向经直肠超声（TRUS）引导活检、靶向磁共振引导的孔内活检（MRGB）或两种方法联合进行活检时前列腺癌的检出率。
因怀疑前列腺癌（前列腺特异性抗原升高或直肠指检异常）而接受mpMRI（包括T2加权、扩散加权和动态对比增强MRI）检查的未经活检的男性符合纳入标准。图像根据前列腺影像报告和数据系统（PI-RADS）v2进行评分，PI-RADS 1-2级病变的男性接受常规系统性TRUS检查，而PI-RADS 3-5级病变的男性被随机分配接受MRGB或认知靶向TRUS检查。随机接受MRGB检查的男性在MRGB检查后2周接受二次TRUS检查。 Gleason分级组≥2被定义为具有临床意义的前列腺癌。以任何活检方法检测到的前列腺癌作为参考标准来评估mpMRI的性能。
共纳入210名男性。48%的男性在mpMRI检查后（PI-RADS 1-2）未怀疑前列腺癌。其中，分别有5名和11名男性被诊断为有临床意义和无临床意义的前列腺癌。35名PI-RADS 1-2级评分的男性未接受活检，因此被排除在诊断准确性计算之外。mpMRI检测有临床意义前列腺癌的总体敏感性、特异性、阴性预测值和阳性预测值分别为0.94、0.63、0.92和0.67。在PI-RADS 3-5级病变的患者中，认知靶向TRUS（68.4%）、MRGB（57.7%）和两种活检方法联合使用（64.4%）对有临床意义前列腺癌的检出率无显著差异。接受系统性TRUS、认知靶向TRUS和MRGB检查的患者，每位患者活检核心的中位数分别为14[8-16]、12[6-17]和2[1-4]。
在未经活检的男性队列中，mpMRI具有较高的阴性预测值，我们的结果支持mpMRI检查结果为阴性后避免活检是安全的。此外，MRGB与认知靶向TRUS提供相似的诊断，但活检次数更少。
