Yuan Chang Wei, Li De Run, Li Zhi Hua, Liu Yi, Shan Gang Zhi, Li Xue Song, Zhou Li Qun
Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Oct 18;55(5):838-842. doi: 10.19723/j.issn.1671-167X.2023.05.010.
To evaluate the diagnostic value of dynamic contrast enhanced (DCE) of multiparametric magnetic resonance imaging (mpMRI) for prostate imaging reporting and data system (PI-RADS) 4 lesion in prostate peripheral zone.
The clinical data of patients with PI-RADS 4 lesion in prostate peripheral zone who underwent prostate biopsy from January 2018 to September 2021 in Peking University First Hospital were retrospectively included. According to DCE status, the patients were divided into the conventional group (4 points for diffusion-weighted imaging) and the comprehensive group (3 points for diffusion-weighted imaging + 1 point for DCE positive). Pearson's chi-square test or Fisher's exact test for comparison was conducted between prostate cancer and non-cancer patients. Univariate and multivariate Logistic regression were performed to analyze the correlation of positive biopsy with age, total prostate specific antigen (PSA), free PSA/total PSA (f/tPSA), prostate volume (PV), PSA density (PSAD) and DCE status.
Among the 267 prostate biopsy patients, 217 cases were diagnosed as prostatic cancer (81.27%) and 50 cases were non-cancer (18.73%). Statistical analysis between the prostatic cancer group and the non-cancer group showed that there were significant differences in age, tPSA, PV and PSAD (all < 0.05), but no significant differences in f/tPSA between the two groups. About different PI-RADS 4 lesion groups, the conventional group and the comprehensive group showed significant difference in biopsy results (=0.001), and the conventional group had a higher positive rate. The PV of comprehensive group was larger than that of the conventional group. Among the prostate cancer patients diagnosed by biopsy, statistical analysis between the conventional group and comprehensive group showed that there were not significant differences in International Society of Urological Pathology (ISUP) grade and distinguishing clinically significant prostate cancer (all > 0.05). Logistic univariate analysis showed that the diagnosis of prostate cancer was related to age, tPSA, f/tPSA, PV and DCE group status (all < 0.05). Multivariate analysis showed that age, tPSA, PV and DCE group status (all < 0.05) were independent risk factors for the diagnosis of prostatic cancer.
tPSA, f/tPSA, PV and PSAD are the indicators to improve the diagnosis of prostatic cancer with PI-RADS 4 lesion in peripheral zone lesions. DCE status is worth considering, so that we can select patients for biopsy more accurately, reduce the rate of missed diagnosis of prostate cancer as well as avoid unnecessary prostate puncture.
评估多参数磁共振成像（mpMRI）的动态对比增强（DCE）对前列腺外周带前列腺影像报告和数据系统（PI-RADS）4类病变的诊断价值。
回顾性纳入2018年1月至2021年9月在北京大学第一医院接受前列腺穿刺活检的前列腺外周带PI-RADS 4类病变患者的临床资料。根据DCE状态，将患者分为传统组（扩散加权成像4分）和综合组（扩散加权成像3分+DCE阳性1分）。对前列腺癌患者和非癌患者进行Pearson卡方检验或Fisher精确检验以作比较。进行单因素和多因素Logistic回归分析，以分析穿刺活检阳性与年龄、总前列腺特异性抗原（PSA）、游离PSA/总PSA（f/tPSA）、前列腺体积（PV）、PSA密度（PSAD）及DCE状态的相关性。
267例前列腺穿刺活检患者中，217例被诊断为前列腺癌（81.27%），50例为非癌（18.73%）。前列腺癌组与非癌组的统计学分析显示，年龄、总PSA、PV和PSAD存在显著差异（均<0.05），但两组间f/tPSA无显著差异。关于不同的PI-RADS 4类病变组，传统组和综合组在活检结果上存在显著差异（=0.001），传统组的阳性率更高。综合组的PV大于传统组。在经活检确诊的前列腺癌患者中，传统组和综合组在国际泌尿病理学会（ISUP）分级和鉴别临床有意义的前列腺癌方面的统计学分析显示无显著差异（均>0.05）。Logistic单因素分析显示，前列腺癌的诊断与年龄、总PSA、f/tPSA、PV及DCE组状态有关（均<0.05）。多因素分析显示，年龄、总PSA、PV及DCE组状态（均<0.05）是前列腺癌诊断的独立危险因素。
总PSA、f/tPSA、PV和PSAD是提高外周带PI-RADS 4类病变前列腺癌诊断的指标。DCE状态值得考虑，以便更准确地选择穿刺活检患者，降低前列腺癌漏诊率，同时避免不必要的前列腺穿刺。
