CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
Department of Radiology, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
Can Assoc Radiol J. 2022 Aug;73(3):515-523. doi: 10.1177/08465371211073158. Epub 2022 Feb 24.
To assess the added value of histological information for local staging of prostate cancer (PCa) by comparing the accuracy of multiparametric MRI alone (mpMRI) and mpMRI with biopsy Gleason grade (mpMRI+Bx).
133 consecutive patients who underwent preoperative 3T-MRI and subsequent radical prostatectomy for PCa were included in this single-centre retrospective study. mpMRI imaging was reviewed independently by two uroradiologists for the presence of extracapsular extension (ECE) and seminal vesicle invasion (SVI) on a 5-point Likert scale. For second reads, the radiologists received results of targeted fused MR/US biopsy (mpMRI+Bx) prior to re-staging.
The median patient age was 63 years (interquartile range (IQR) 58-67 years) and median PSA was 6.5 ng/mL (IQR 5.0-10.0 ng/mL). Extracapsular extension was present in 85/133 (63.9%) patients and SVI was present in 22/133 (16.5%) patients. For ECE prediction, mpMRI showed sensitivity and specificity of 63.5% and 81.3%, respectively, compared to 77.7% and 81.3% achieved by mpMRI+Bx. At an optimal cut-off value of Likert score ≥ 3, areas under the curves (AUCs) was .85 for mpMRI+Bx and .78 for mpMRI, < .01. For SVI prediction, AUC was .95 for mpMRI+Bx compared to .92 for mpMRI; = .20. Inter-reader agreement for ECE and SVI prediction was substantial for mpMRI (k range, .78-.79) and mpMRI+Bx (k range, .74-.79).
MpMRI+Bx showed superior diagnostic performance with an increased sensitivity for ECE prediction but no significant difference for SVI prediction. Inter-reader agreement was substantial for both protocols. Integration of biopsy information adds value when staging prostate mpMRI.
通过比较单独多参数 MRI（mpMRI）和 mpMRI 联合活检 Gleason 分级（mpMRI+Bx）对前列腺癌（PCa）局部分期的准确性，评估组织学信息的附加价值。
本研究为单中心回顾性研究，共纳入 133 例接受术前 3T-MRI 检查和随后根治性前列腺切除术的 PCa 连续患者。两名泌尿放射科医生独立对 MRI 图像进行评估，以 5 分 Likert 量表评估有无包膜外延伸（ECE）和精囊侵犯（SVI）。对于二次读片，放射科医生在重新分期前收到了靶向融合 MR/US 活检（mpMRI+Bx）的结果。
中位患者年龄为 63 岁（四分位距（IQR）58-67 岁），中位 PSA 为 6.5ng/mL（IQR 5.0-10.0ng/mL）。133 例患者中 85 例（63.9%）存在包膜外延伸，22 例（16.5%）存在精囊侵犯。对于 ECE 预测，mpMRI 的敏感性和特异性分别为 63.5%和 81.3%，mpMRI+Bx 分别为 77.7%和 81.3%。Likert 评分≥3 的最佳截断值时，mpMRI+Bx 的曲线下面积（AUC）为 0.85，mpMRI 为 0.78，<0.01。对于 SVI 预测，mpMRI+Bx 的 AUC 为 0.95，mpMRI 为 0.92，=0.20。ECE 和 SVI 预测的 mpMRI 和 mpMRI+Bx 的读者间一致性均为中等（k 范围，0.78-0.79）。
mpMRI+Bx 显示出更好的诊断性能，ECE 预测的敏感性增加，但 SVI 预测无显著差异。两种方案的读者间一致性均为中等。当对前列腺 mpMRI 进行分期时，活检信息的整合具有附加价值。
