经腹和经会阴超声前列腺特异性抗原（PSA）密度评估与 MRI 前列腺体积比较：一项可行性研究。
Evaluation of transabdominal and transperineal ultrasound-derived prostate specific antigen (PSA) density and clinical utility compared to MRI prostate volumes: A feasibility study.
机构信息
Department of Radiology, Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom.
Cambridge Urology Translational Research and Clinical Trials Office, University of Cambridge, Cambridge, United Kingdom.
出版信息
PLoS One. 2022 Sep 9;17(9):e0274014. doi: 10.1371/journal.pone.0274014. eCollection 2022.
PURPOSE
To investigate the accuracy of surface-based ultrasound-derived PSA-density (US-PSAD) versus gold-standard MRI-PSAD as a risk-stratification tool.
METHODS
Single-centre prospective study of patients undergoing MRI for suspected prostate cancer (PCa). Four combinations of US-volumes were calculated using transperineal (TP) and transabdominal (TA) views, with triplanar measurements to calculate volume and US-PSAD. Intra-class correlation coefficient (ICC) was used to compare US and MRI volumes. Categorical comparison of MRI-PSAD and US-PSAD was performed at PSAD cut-offs <0.15, 0.15-0.20, and >0.20 ng/mL2 to assess agreement with MRI-PSAD risk-stratification decisions.
RESULTS
64 men were investigated, mean age 69 years and PSA 7.0 ng/mL. 36/64 had biopsy-confirmed prostate cancer (18 Gleason 3+3, 18 Gleason ≥3+4). Mean MRI-derived gland volume was 60 mL, compared to 56 mL for TA-US, and 65 mL TP-US. ICC demonstrated good agreement for all US volumes with MRI, with highest agreement for transabdominal US, followed by combined TA/TP volumes. Risk-stratification decisions to biopsy showed concordant agreement between triplanar MRI-PSAD and ultrasound-PSAD in 86-91% and 92-95% at PSAD thresholds of >0.15 ng/mL2 and >0.12 ng/mL2, respectively. Decision to biopsy at threshold >0.12 ng/mL2, demonstrated sensitivity ranges of 81-100%, specificity 85-100%, PPV 86-100% and NPV 83-100%. Transabdominal US provided optimal sensitivity of 100% for this clinical decision, with specificity 85%, and transperineal US provided optimal specificity of 100%, with sensitivity 87%.
CONCLUSION
Transperineal-US and combined TA-TP US-derived PSA density values compare well with standard MRI-derived values and could be used to provide accurate PSAD at presentation and inform the need for further investigations.
目的
研究基于表面的超声前列腺特异性抗原密度（US-PSAD）与金标准 MRI-PSAD 作为风险分层工具的准确性。
方法
对因疑似前列腺癌（PCa）而行 MRI 检查的患者进行单中心前瞻性研究。使用经会阴（TP）和经腹（TA）视图计算了 4 种 US 体积组合，并进行了三平面测量以计算体积和 US-PSAD。使用组内相关系数（ICC）比较 US 和 MRI 体积。在 PSA 密度截断值<0.15、0.15-0.20 和>0.20 ng/mL2 时，对 MRI-PSAD 和 US-PSAD 进行分类比较，以评估与 MRI-PSAD 风险分层决策的一致性。
结果
共纳入 64 名男性患者，平均年龄 69 岁，PSA 为 7.0 ng/mL。36/64 例经活检证实为前列腺癌（18 例 Gleason 评分 3+3，18 例 Gleason 评分≥3+4）。平均 MRI 得出的腺体体积为 60 mL，TA-US 为 56 mL，TP-US 为 65 mL。ICC 显示所有 US 体积与 MRI 均具有良好的一致性，其中经腹 US 一致性最高，其次是 TA/TP 联合 US。在 PSA 密度截断值>0.15 ng/mL2 和>0.12 ng/mL2 时，三平面 MRI-PSAD 和超声-PSAD 之间的活检风险分层决策具有一致的一致性，分别为 86-91%和 92-95%。在阈值>0.12 ng/mL2 时进行活检的决策，其灵敏度范围为 81-100%，特异性为 85-100%，PPV 为 86-100%，NPV 为 83-100%。经腹 US 在此临床决策中提供了 100%的最佳灵敏度，特异性为 85%，经会阴 US 提供了 100%的最佳特异性，灵敏度为 87%。
结论
经会阴-US 和 TA-TP 联合 US 衍生的 PSA 密度值与标准 MRI 衍生值相比具有良好的可比性，可用于提供准确的 PSA 密度值，并有助于确定是否需要进一步检查。
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