Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy.
Urology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy.
Eur Radiol. 2022 Jul;32(7):4942-4953. doi: 10.1007/s00330-022-08595-9. Epub 2022 Mar 15.
To investigate the diagnostic accuracy of the PI-RADS v2.1 multiparametric magnetic resonance imaging (mpMRI) features in predicting extraprostatic extension (mEPE) of prostate cancer (PCa), as well as to develop and validate a comprehensive mpMRI-derived score (mEPE-score).
We retrospectively reviewed all consecutive patients admitted to two institutions for radical prostatectomy for PCa with available records of mpMRI performed between January 2015 and December 2020. Data from one institution was used for investigating diagnostic performance of each mEPE feature using radical prostatectomy specimens as benchmark. The results were implemented in a mEPE-score as follows: no mEPE features: 1; capsular abutment: 2; irregular or spiculated margin: 3; bulging prostatic contour, or asymmetry of the neurovascular bundles, or tumor-capsule interface > 1.0 cm: 4; ≥ 2 of the previous three parameters or measurable extraprostatic disease: 5. The performance of mEPE features was evaluated using the five diagnostic parameters and ROC curve analysis.
Two-hundred patients were enrolled at site 1 and 76 at site 2. mEPE features had poor sensitivities ranging from 0.08 (0.00-0.15) to 0.71 (0.59-0.83), whereas specificity ranged from 0.68 (0.58-0.79) to 1.00. mEPE-score showed excellent discriminating ability (AUC > 0.8) and sensitivity = 0.82 and specificity = 0.77 with a threshold of 3. mEPE-score had AUC comparable to ESUR-score (p = 0.59 internal validation; p = 0.82 external validation), higher than or comparable to mEPE-grade (p = 0.04 internal validation; p = 0.58 external validation), and higher than early-and-late-EPE (p < 0.0001 internal and external validation). There were no significant differences between readers having different expertise with EPE-score (p = 0.32) or mEPE-grade (p = 0.45), but there were significant differences for ESUR-score (p = 0.02) and early-versus-late-EPE (p = 0.03).
The individual mEPE features have low sensitivity and high specificity. The use of mEPE-score allows for consistent and reliable assessment for pathologic EPE.
• Individual PI-RADS v2.1 mpMRI features had poor sensitivities ranging from 0.08 (0.00-0.15) to 0.71 (0.59-0.83), whereas Sp ranged from 0.68 (0.58-0.79) to 1.00. • mEPE-score is an all-inclusive score for the assessment of pEPE with excellent discriminating ability (i.e., AUC > 0.8) and Se = 0.82, Sp = 0.77, PPV = 0.74, and NPV = 0.84 with a threshold of 3. • The diagnostic performance of the expert reader and beginner reader with pEPE-score was comparable (p = 0.32).
研究 PI-RADS v2.1 多参数磁共振成像（mpMRI）特征在预测前列腺癌（PCa）前列腺外延伸（mEPE）中的诊断准确性，并开发和验证综合的 mpMRI 衍生评分（mEPE-score）。
我们回顾性分析了 2015 年 1 月至 2020 年 12 月期间在两个机构因 PCa 接受根治性前列腺切除术且有 mpMRI 记录的所有连续患者。一家机构的数据用于使用根治性前列腺切除术标本作为基准来研究每个 mEPE 特征的诊断性能。结果在 mEPE-score 中实施如下：无 mEPE 特征：1；包膜侵犯：2；不规则或刺状边缘：3；前列腺轮廓隆起，或神经血管束不对称，或肿瘤包膜界面>1.0cm：4；前三个参数中的≥2 个或可测量的前列腺外疾病：5。使用五个诊断参数和 ROC 曲线分析评估 mEPE 特征的性能。
site1 纳入了 200 例患者，site2 纳入了 76 例患者。mEPE 特征的敏感性范围从 0.08（0.00-0.15）到 0.71（0.59-0.83），特异性范围从 0.68（0.58-0.79）到 1.00。mEPE-score 具有出色的鉴别能力（AUC>0.8）和敏感性=0.82，特异性=0.77，阈值为 3。mEPE-score 的 AUC 与 ESUR-score 相当（p=0.59 内部验证；p=0.82 外部验证），高于或与 mEPE-grade 相当（p=0.04 内部验证；p=0.58 外部验证），高于早期和晚期 EPE（p<0.0001 内部和外部验证）。具有不同 EPE-score 经验的读者之间（p=0.32）或 mEPE-grade（p=0.45）没有显著差异，但 ESUR-score（p=0.02）和早期与晚期 EPE（p=0.03）之间存在显著差异。
个体 mEPE 特征的敏感性较低，特异性较高。使用 mEPE-score 可以对病理 EPE 进行一致且可靠的评估。
个体 PI-RADS v2.1 mpMRI 特征的敏感性范围从 0.08（0.00-0.15）到 0.71（0.59-0.83），特异性范围从 0.68（0.58-0.79）到 1.00。
mEPE-score 是一种全面的评估 pEPE 的评分，具有出色的鉴别能力（即 AUC>0.8）和敏感性=0.82，特异性=0.77，PPV=0.74，NPV=0.84，阈值为 3。
专家读者和初学者读者使用 pEPE-score 的诊断性能相当（p=0.32）。
