Platt J F, Bree R L, Schwab R E
AJR Am J Roentgenol. 1987 Aug;149(2):315-8. doi: 10.2214/ajr.149.2.315.
Previous studies have reported the accuracy of CT in distinguishing stages of prostatic carcinoma, but they lack uniform surgical proof of histopathologic stage. We evaluated CT scans in 32 patients who underwent radical prostatectomy to assess its role in the preoperative staging of prostatic carcinoma. Two experienced radiologists blindly interpreted CT scans of the pelvis; they looked for evidence of tumor beyond the prostatic capsule and involvement of the seminal vesicles (stage C) or involvement of pelvic lymph nodes (stage D). Sixty-four interpretations in 32 patients yielded a specificity of 75% for predicting stages A or B disease (local disease), a sensitivity of 50% for the prediction of stages C or D, and an overall accuracy of staging of 67%. Interpretation errors were due to an inability to detect lymph node metastases, errors in evaluating the seminal vesicles, and errors in interpreting densities surrounding the prostate gland. Our data suggest that CT should not be used to influence decisions concerning surgical vs nonsurgical treatment in patients with clinically staged local disease and is only useful when unsuspected metastatic nodal disease is detected.
以往的研究报告了CT在鉴别前列腺癌分期方面的准确性，但它们缺乏组织病理学分期的统一手术证据。我们对32例行根治性前列腺切除术的患者进行了CT扫描评估，以确定其在前列腺癌术前分期中的作用。两位经验丰富的放射科医生对骨盆CT扫描结果进行了盲法解读；他们寻找前列腺包膜外肿瘤的证据以及精囊受累（C期）或盆腔淋巴结受累（D期）的证据。对32例患者的64次解读结果显示，预测A期或B期疾病（局部疾病）的特异性为75%，预测C期或D期的敏感性为50%，总体分期准确率为67%。解读错误的原因包括无法检测到淋巴结转移、精囊评估错误以及前列腺周围密度解读错误。我们的数据表明，对于临床分期为局部疾病的患者，CT不应被用于影响手术与非手术治疗的决策，仅在检测到意外的转移性淋巴结疾病时才有用。
