具有筛状结构的前列腺腺癌在前列腺 MRI 上更难检测到吗？
Is prostatic adenocarcinoma with cribriform architecture more difficult to detect on prostate MRI?
机构信息
Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
出版信息
Prostate. 2023 Dec;83(16):1519-1528. doi: 10.1002/pros.24610. Epub 2023 Aug 25.
BACKGROUND
Cribriform (CBFM) pattern on prostate biopsy has been implicated as a predictor for high-risk features, potentially leading to adverse outcomes after definitive treatment. This study aims to investigate whether the CBFM pattern containing prostate cancers (PCa) were associated with false negative magnetic resonance imaging (MRI) and determine the association between MRI and histopathological disease burden.
METHODS
Patients who underwent multiparametric magnetic resonance imaging (mpMRI), combined 12-core transrectal ultrasound (TRUS) guided systematic (SB) and MRI/US fusion-guided biopsy were retrospectively queried for the presence of CBFM pattern at biopsy. Biopsy cores and lesions were categorized as follows: C0 = benign, C1 = PCa with no CBFM pattern, C2 = PCa with CBFM pattern. Correlation between cancer core length (CCL) and measured MRI lesion dimension were assessed using a modified Pearson correlation test for clustered data. Differences between the biopsy core groups were assessed with the Wilcoxon-signed rank test with clustering.
RESULTS
Between 2015 and 2022, a total of 131 consecutive patients with CBFM pattern on prostate biopsy and pre-biopsy mpMRI were included. Clinical feature analysis included 1572 systematic biopsy cores (1149 C0, 272 C1, 151 C2) and 736 MRI-targeted biopsy cores (253 C0, 272 C1, 211 C2). Of the 131 patients with confirmed CBFM pathology, targeted biopsy (TBx) alone identified CBFM in 76.3% (100/131) of patients and detected PCa in 97.7% (128/131) patients. SBx biopsy alone detected CBFM in 61.1% (80/131) of patients and PCa in 90.8% (119/131) patients. TBx and SBx had equivalent detection in patients with smaller prostates (p = 0.045). For both PCa lesion groups there was a positive and significant correlation between maximum MRI lesion dimension and CCL (C1 lesions: p < 0.01, C2 lesions: p < 0.001). There was a significant difference in CCL between C1 and C2 lesions for T2 scores of 3 and 5 (p ≤ 0.01, p ≤ 0.01, respectively) and PI-RADS 5 lesions (p ≤ 0.01), with C2 lesions having larger CCL, despite no significant difference in MRI lesion dimension.
CONCLUSIONS
The extent of disease for CBFM-containing tumors is difficult to capture on mpMRI. When comparing MRI lesions of similar dimensions and PIRADS scores, CBFM-containing tumors appear to have larger cancer yield on biopsy. Proper staging and planning of therapeutic interventions is reliant on accurate mpMRI estimation. Special considerations should be taken for patients with CBFM pattern on prostate biopsy.
背景
前列腺活检中的筛状（CBFM）模式被认为是高危特征的预测因子，可能导致明确治疗后的不良结局。本研究旨在探讨是否含有 CBFM 模式的前列腺癌（PCa）与阴性磁共振成像（MRI）相关，并确定 MRI 与组织病理学疾病负担之间的关联。
方法
回顾性分析了 2015 年至 2022 年期间在我院接受多参数磁共振成像（mpMRI）、12 芯经直肠超声（TRUS）引导的系统（SB）和 MRI/US 融合引导活检的患者，是否存在前列腺活检中的 CBFM 模式。活检核心和病变分为以下几类：C0=良性，C1=无 CBFM 模式的 PCa，C2=有 CBFM 模式的 PCa。使用改良的 Pearson 相关检验评估癌症核心长度（CCL）与测量的 MRI 病变维度之间的相关性，采用聚类数据的符号秩检验评估活检核心组之间的差异。
结果
共纳入了 131 例前列腺活检中存在 CBFM 模式且有术前 mpMRI 的连续患者。临床特征分析包括 1572 例系统活检核心（1149 例 C0、272 例 C1、151 例 C2）和 736 例 MRI 靶向活检核心（253 例 C0、272 例 C1、211 例 C2）。在 131 例证实存在 CBFM 病理的患者中，单独进行靶向活检（TBx）可在 76.3%（100/131）的患者中识别出 CBFM，并在 97.7%（128/131）的患者中检测到 PCa。单独进行 SBx 活检可在 61.1%（80/131）的患者中识别出 CBFM，并在 90.8%（119/131）的患者中检测到 PCa。在前列腺较小的患者中，TBx 和 SBx 的检测具有等效性（p=0.045）。对于 PCa 病变组，最大 MRI 病变维度与 CCL 之间均存在正相关（C1 病变：p<0.01，C2 病变：p<0.001）。对于 T2 评分为 3 和 5（p≤0.01，p≤0.01，分别）和 PI-RADS 5 病变（p≤0.01）的患者，C1 和 C2 病变之间的 CCL 存在显著差异，尽管 MRI 病变维度无显著差异，但 C2 病变的 CCL 更大。
结论
CBFM 模式肿瘤的疾病程度难以在 mpMRI 上捕捉到。当比较具有相似尺寸和 PI-RADS 评分的 MRI 病变时，含有 CBFM 模式的肿瘤在活检中似乎具有更大的癌症检出率。准确的 mpMRI 估计是进行适当分期和治疗干预计划的关键。对于前列腺活检中存在 CBFM 模式的患者，应给予特殊考虑。
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