Abdul Raheem Rickaz, Razzaq Ahsen, Beraud Victoria, Menzies-Wilson Richard, Odeh Rakan, Ibiok Imoh, Mulawkar Prashant, Andrews Henry, Anjum Iqbal, Hosny Khaled, Leslie Tom
Speciality Doctor in Urology, Milton Keynes University Hospital, UK.
University of Buckingham Medical School.
Arab J Urol. 2022 Sep 13;21(1):10-17. doi: 10.1080/2090598X.2022.2119711. eCollection 2023.
Multi-parametric magnetic resonance imaging (mp-MRI) is currently used to triage patients with suspected prostate cancer, before deciding on prostate biopsies. In our study, we evaluated normal and equivocal pre-biopsy mp-MRIs to see whether it is safe to avoid biopsy with such findings.
A retrospective study was conducted at a district general hospital in the UK between August 2017 and July 2018. Patients with negative and equivocal prebiopsy mp-MRI with high clinical suspicion of cancer had proceeded to biopsy. MRI reports with prostate imaging reporting and data system (PI-RADS) scores 1, 2, 3 and normal MRI were evaluated against the transrectal ultrasound-guided prostate biopsy (TRUS-PB) outcomes to demonstrate benign pathology, clinically insignificant or clinically significant cancer (csCa). CsCa was defined as Gleason score (GS) ≥3 + 4.
Out of 265 mp-MRIs studied, five (1.9%) were PI-RADS 1, 109 (41.1%) and 84 (31.7%) were PI-RADS 2 and 3 lesions respectively; 67 (25.3%) were reported as normal. Seventy-five (27.3%) patients did not have biopsies following their MRI and 73.3% (51/75) of them had benign feeling prostate. Negative MRIs (PI-RADS 1, 2 and normal MRI) showed 8.8% and PI-RADS 3 lesions demonstrated 11.9% csCa. Negative predictive value for normal MRI was 91.2%. Mean PSA density (PSAD) among the benign, GS 3 + 3 and csCa was 0.14, 0.16 and 0.27 ng/ml/ml respectively and this was statistically significant ( < 0.001). The average percentage of cancer found in GS 3 + 3 and csCa was 3.2% and 20.1%, respectively.
Avoiding TRUS-PB following normal or equivocal mp-MRI should carefully be decided as 18.5% of cancer was demonstrated in this group and 9.8% of those who were diagnosed with cancer were csCa. PSAD and DRE findings provide additional information to help with this decision.
在决定是否进行前列腺活检之前，多参数磁共振成像（mp-MRI）目前用于对疑似前列腺癌患者进行分类。在我们的研究中，我们评估了活检前正常和可疑的mp-MRI，以确定对于此类检查结果避免活检是否安全。
2017年8月至2018年7月在英国一家地区综合医院进行了一项回顾性研究。临床高度怀疑患有癌症但活检前mp-MRI结果为阴性和可疑的患者进行了活检。将前列腺影像报告和数据系统（PI-RADS）评分为1、2、3的MRI报告以及正常MRI与经直肠超声引导下前列腺活检（TRUS-PB）结果进行对照，以证明为良性病变、临床意义不显著或临床意义显著的癌症（csCa）。csCa定义为 Gleason评分（GS）≥3 + 4。
在研究的265例mp-MRI中，5例（1.9%）为PI-RADS 1，109例（41.1%）和84例（31.7%）分别为PI-RADS 2和3级病变；67例（25.3%）报告为正常。75例（27.3%）患者在MRI检查后未进行活检，其中73.3%（51/75）的患者前列腺质地柔软。阴性MRI（PI-RADS 1、2和正常MRI）显示csCa的比例为8.8%，PI-RADS 3级病变显示csCa的比例为11.9%。正常MRI的阴性预测值为91.2%。良性、GS 3 + 3和csCa患者的平均前列腺特异抗原密度（PSAD）分别为0.14、0.16和0.27 ng/ml/ml，差异具有统计学意义（<0.001）。GS 3 + 3和csCa患者中发现癌症的平均百分比分别为3.2%和20.1%。
对于正常或可疑的mp-MRI后避免进行TRUS-PB应谨慎决定，因为该组中有18.5%的患者被证实患有癌症，其中9.8%被诊断为癌症的患者为csCa。PSAD和直肠指检结果为这一决定提供了额外的信息。
