Hong Sung Kyu, Song Sang Hun, Kim Hak Ju, Lee Hae Sung, Nam Jun Hyun, Lee Seung Bae
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Prostate Int. 2022 Dec;10(4):188-193. doi: 10.1016/j.prnil.2022.07.001. Epub 2022 Jul 19.
To assess temporal improvement of prostate image reporting and data system (PIRADS) 3-5 lesion correlation to histopathologic findings from radical prostatectomy (RP) in prostate cancer (PCa).
A total of 1481 patients who underwent RP for biopsy-proven PCa between 2015 and 2019 were divided into 14 groups of 100 sequential readings for the evaluation of histopathological correlation with PIRADS readings. Temporal trends of PIRADS distribution and predictive performance for RP pathology were evaluated to assess underlying changes in prostate magnetic resonance imaging (MRI) interpretation by radiologists.
PIRADS 4-5 lesions were significantly correlated with the increasing rates of Gleason Group (GG) upgrade (p = 0.044) and decreasing rate of GG downgrade (p = 0.016) over time. PIRADS ≥3 lesions read after median 2 years of experience were shown to independently predict intermediate-high-risk (GG ≥ 3) PCa (odds ratio 2.93, 95% confidence interval 1.00-8.54; = 0.049) in RP pathology. Preoperative GG ≥ 3 biopsy lesions with PIRADS 4-5 lesions were significantly more susceptible to GG upgrade (= 0.035) and GG ≥ 4 RP pathology (p = 0.003) in experienced reads, in contrast to insignificant findings in early readings (p = 0.588 and 0.248, respectively).
Preoperative MRI reports matched with RP pathology suggest an improved prediction of adverse pathology in PIRADS 3-5 lesions over time, suggesting a temporal change in PIRADS interpretation and predictive accuracy. Institutions with low volume experience should use caution in solely relying on MRI for predicting tumor characteristics. Future prospective trials and larger scale assessments are required to further validate our results.
评估前列腺影像报告和数据系统（PIRADS）3 - 5级病变与前列腺癌（PCa）根治性前列腺切除术（RP）组织病理学结果的时间相关性。
2015年至2019年间，共有1481例经活检证实为PCa并接受RP的患者被分为14组，每组100次连续读数，以评估与PIRADS读数的组织病理学相关性。评估PIRADS分布的时间趋势以及RP病理的预测性能，以评估放射科医生对前列腺磁共振成像（MRI）解读的潜在变化。
随着时间的推移，PIRADS 4 - 5级病变与Gleason分级组（GG）升级率增加（p = 0.044）和GG降级率降低（p = 0.016）显著相关。在有中位数2年经验后读取的PIRADS≥3级病变被证明可独立预测RP病理中的中高危（GG≥3）PCa（优势比2.93，95%置信区间1.00 - 8.54；p = 0.049）。在经验丰富的读数中，术前GG≥3活检病变伴有PIRADS 4 - 5级病变更易发生GG升级（p = 0.035）和GG≥4的RP病理（p = 0.003），而在早期读数中结果不显著（分别为p = 0.588和0.248）。
术前MRI报告与RP病理相匹配表明，随着时间的推移，PIRADS 3 - 5级病变对不良病理的预测有所改善，提示PIRADS解读和预测准确性存在时间变化。经验较少的机构在仅依靠MRI预测肿瘤特征时应谨慎。未来需要进行前瞻性试验和更大规模的评估以进一步验证我们的结果。
