Martell Kevin, Chung Hans, Morton Gerard, Vesprini Danny, Tseng Chia-Lin, Szumacher Ewa, Cheung Patrick, Chu Will, Liu Stanley, Loblaw Andrew
Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
Can Urol Assoc J. 2022 Aug;16(8):E437-E442. doi: 10.5489/cuaj.7752.
We aimed to determine the minimum cross-sectional ellipsoid area on magnetic resonance (MR) of intraprostatic nodules that best predicts for subsequent targeted biopsies revealing ≥ grade group (GG) 2 disease.
Forty-six patients previously diagnosed with GG 1 prostate adenocarcinoma who received cognitively fused, MR-guided, transperineal targeted biopsies in addition to six random biopsies were included in this analysis. A Youden cutpoint analysis was used to determine the ellipsoid area in the axial plane best predicting for ≥GG 2 disease within the targeted biopsy cores and logistic regression used to assess the result.
Median time from MR imaging to targeted biopsy was 2.4 (1.4-5.5) months. Forty of 46 (87%) patients had one nodule and 6/46 (13%) had two separate nodules on MR that received targeted biopsy. Of the 52 nodules, five (10%), 33 (63%), and 14 (27%) were Prostate Imaging-Reporting and Data System (PI-RADS) 3, 4, and 5, respectively. Thirteen (25%), six (12%), and 33 (64%) were in the anterior, medial, and posterior regions of the prostate, respectively. Median area was 0.72 (0.49-1.29) cm (average diameter 9.5 mm). Fifteen of 46 (33%) patients had ≥1 random biopsy and 20/52 (38%) nodules had ≥1 targeted biopsy revealing ≥GG 2 disease. The optimal area cutpoint was ≥0.7 cm, with an area under the curve of 0.671 (0.510-0.832). On logistic regression, area ≥0.7 cm was solely predictive of targeted biopsy revealing ≥GG 2 disease (odds ratio 6.5, 1.3-32.4, p=0.022).
Nodule area ≥0.7 cm may predict for transperineal-based targeted biopsies being positive for ≥GG 2 disease when 1-2 cores are taken.
我们旨在确定前列腺内结节在磁共振成像（MR）上的最小横断面椭圆面积，该面积能最准确预测后续靶向活检显示≥2级组（GG）疾病。
本分析纳入了46例先前诊断为GG 1前列腺腺癌的患者，这些患者除了接受6次随机活检外，还接受了认知融合、MR引导的经会阴靶向活检。采用约登切点分析来确定轴向平面上最能预测靶向活检核心内≥GG 2疾病的椭圆面积，并使用逻辑回归评估结果。
从MR成像到靶向活检的中位时间为2.4（1.4 - 5.5）个月。46例患者中有40例（87%）有一个结节，6例（13%）有两个独立结节接受了靶向活检。在52个结节中，分别有5个（10%）、33个（63%）和14个（27%）为前列腺影像报告和数据系统（PI-RADS）3、4和5级。分别有13个（25%）、6个（12%）和33个（64%）位于前列腺的前部、中部和后部区域。中位面积为0.72（0.49 - 1.29）平方厘米（平均直径9.5毫米）。46例患者中有15例（33%）进行了≥一次随机活检，5个结节中有20个（38%）进行了≥一次靶向活检显示≥GG 2疾病。最佳面积切点为≥0.7平方厘米，曲线下面积为0.671（0.510 - 0.832）。在逻辑回归分析中，面积≥0.7平方厘米是靶向活检显示≥GG 2疾病的唯一预测因素（比值比6.5，1.3 - 32.4，p = 0.022）。
当取1 - 2个核心时，结节面积≥0.7平方厘米可能预测经会阴靶向活检对≥GG 2疾病呈阳性。
