El-Helaly Hesham Abdel-Azim, Mahmoud Asem Abdel-Aziz, Magdy Ahmed Mohamed, Hasehem Abdelwahab, Ibrahim Hamdy Mohamed, Mohamed Khaled Moheyelden, Ismail Mohamed Hamdy
Urology Department, Fayoum University, Fayoum, Egypt.
Radiology Department, Fayoum University, Fayoum, Egypt.
J Egypt Natl Canc Inst. 2023 Mar 6;35(1):5. doi: 10.1186/s43046-023-00165-4.
Multi-parametric magnetic resonance imaging may improve the detection of prostate cancer. The aim of this work is to compare between PI-RADS 3-5 and PI-RADS 4-5 as a threshold for targeted prostatic biopsy.
This is a prospective clinical study that included 40 biopsy-naïve patients referred for prostate biopsy. Patients underwent prebiopsy multi-parametric (mp-MRI), followed by 12-core transrectal ultrasound-guided systematic biopsy and cognitive MRI/TRUS fusion targeted biopsy from each detected lesion. The primary endpoint was to assess the diagnostic accuracy of the PI-RAD 3-4 versus PI-RADS 4-5 lesion by mpMRI for prostate cancer detection in biopsy-naive men.
The overall prostate cancer detection rate and the clinically significant cancer detection rate were 42.5% and 35%, respectively. Targeted biopsies from PI-RADS 3-5 lesions showed a sensitivity of 100%, specificity of 44%, positive predictive value of 51.7%, and negative predictive value of 100%. Restricting targeted biopsies to PI-RADS 4-5 lesions resulted in a decrease in sensitivity and negative predictive value to 73.3% and 86.2%, respectively, while specificity and positive predictive value were increased to 100% for both parameters which was statistically significant (P value < 0.0001 and P value = 0.004, respectively).
Limiting the TBs to PI-RADS 4-5 lesions improves the performance of mp-MRI in the detection of prostate cancer especially aggressive tumors.
多参数磁共振成像可能会提高前列腺癌的检测率。本研究的目的是比较将PI-RADS 3-5和PI-RADS 4-5作为靶向前列腺活检阈值的差异。
这是一项前瞻性临床研究，纳入了40例初次接受活检的前列腺活检患者。患者在活检前接受多参数（mp-MRI）检查，随后进行12针经直肠超声引导下的系统活检，并对每个检测到的病变进行认知MRI/TRUS融合靶向活检。主要终点是评估mpMRI对PI-RAD 3-4与PI-RADS 4-5病变在初次活检男性中检测前列腺癌的诊断准确性。
总体前列腺癌检测率和临床显著癌检测率分别为42.5%和35%。对PI-RADS 3-5病变进行的靶向活检显示敏感性为100%，特异性为44%，阳性预测值为51.7%，阴性预测值为100%。将靶向活检限制在PI-RADS 4-5病变会导致敏感性和阴性预测值分别降至73.3%和86.2%，而特异性和阳性预测值在这两个参数上均提高到100%，具有统计学意义（P值分别<0.0001和P值=0.004）。
将靶向活检限制在PI-RADS 4-5病变可提高mp-MRI在检测前列腺癌尤其是侵袭性肿瘤方面的性能。
