Wang Y M, Shang J W, Dong L, Liang L H, Zhao R Z, Liang C, Wang S Q, Xia W, Cheng G, Hua L X
Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Zhonghua Zhong Liu Za Zhi. 2023 Nov 23;45(11):942-947. doi: 10.3760/cma.j.cn112152-20220805-00538.
To analyze the relationship between Prostate Imaging Reporting and Data System (PI-RADS) scores and the pathological results of transperineal magnetic resonance-ultrasound fusion guided biopsy. The clinical data, magnetic resonance imaging (MRI) results and prostate puncture biopsies of 517 patients who were assigned to PI-RADS score of 4 or 5 and underwent transperineal magnetic resonance-ultrasound fusion guided biopsy at The First Affiliated Hospital of Nanjing Medical University from June 2019 to March 2022 were retrospectively analyzed. Patients were divided into the PI-RADS 4 and PI-RADS 5 groups according to their PI-RADS scores and were stratified by their prostate specific antigen (PSA) values (PSA<10 ng/ml vs. PSA 10-20 ng/ml). The pathological negative rates from the biopsy, the distribution of the grade groups according to the grading system by World Health Organization/International Society of Urological Pathology (WHO/ISUP), the detection rates of prostate cancer (PCa) and clinically significant prostate cancer (CsPCa)between the groups were compared. 369 patients with a PI-RADS score of 4 and 148 patients with a PI-RADS score of 5 were included in our research. The overall detection rates of PCa and CsPCa were 77.8% (402/517) and 66.7% (345/517), respectively. In the PI-RADS 4 group, patients with prostate negative biopsies or in WHO/ISUP 1, 2, 3, 4, or 5 grade groups accounted for 28.2%, 12.7%, 20.1%, 17.1%, 18.4% and 3.5%, respectively, whereas in the PI-RADS 5 group the rates were 7.4%, 6.8%, 22.3%, 22.3%, 26.4%, and 14.9%, respectively. The difference was statistically significant (<0.001). The detection rates of PCa and CsPCa in the PI-RADS 4 group [71.8% (265/369) vs. 59.1% (218/369), <0.001] were lower than those of the PI-RADS 5 group [92.6% (137/148) vs. 85.8% (127/148), <0.001]. In the PI-RADS 4 group, the proportion of patients classified into WHO/ISUP 4-5 grade groups was lower than that of patients in the PI-RADS 5 group [22.0% (81/369) vs 41.2% (61/148) (<0.001)]. The detection rates of PCa and CsPCa in the PSA<10 ng/ml stratification were less than that in the PSA 10-20 ng/ml stratification[74.1% (281/379) vs. 87.7% (121/138), =0.001], and [60.9% (231/379) vs. 82.6% (114/138), <0.001]. For patients with PSA<10 ng/ml, the detection rates of PCa and CsPCa in the PI-RADS 4 group were less than those in the PI-RADS5 group [70.9% (217/306) vs. 87.7% (64/73), =0.003], and [56.2% (172/306) vs. 80.8% (59/73), <0.001]. For those with a PSA value of 10-20 ng/ml, the detection rates of PCa and CsPCa in the PI-RADS 4 group were less than those in the PI-RADS 5 group [76.2% (48/63) vs. 97.3% (73/75), <0.001], and [73.0% (46/63) vs. 90.7% (68/75), =0.006]. There were statistically significant differences in the proportions of patients with prostate negative biopsy and those falling into WHO/ISUP grade groups 1, 2, 3, 4, or 5 (<0.001) between the PI-RADS 4 group and the PI-RADS 5 group in both stratifications. In this study, the detection rates of CsPCa and PCa in the PI-RADS 4 group were less than those in the PI-RADS 5 group. With the increase of PI-RADS scores, the detection rate of high-grade PCa increased. The same results held for patients with PSA<10 ng/ml or with PSA 10-20 ng/ml.
分析前列腺影像报告和数据系统（PI-RADS）评分与经会阴磁共振-超声融合引导下活检的病理结果之间的关系。回顾性分析2019年6月至2022年3月在南京医科大学第一附属医院接受经会阴磁共振-超声融合引导下活检且PI-RADS评分为4或5的517例患者的临床资料、磁共振成像（MRI）结果及前列腺穿刺活检情况。根据PI-RADS评分将患者分为PI-RADS 4组和PI-RADS 5组，并根据前列腺特异性抗原（PSA）值进行分层（PSA<10 ng/ml与PSA 10 - 20 ng/ml）。比较两组活检的病理阴性率、根据世界卫生组织/国际泌尿病理学会（WHO/ISUP）分级系统的分级组分布、前列腺癌（PCa）及临床显著前列腺癌（CsPCa）的检出率。本研究纳入369例PI-RADS评分为4的患者和148例PI-RADS评分为5的患者。PCa和CsPCa的总体检出率分别为77.8%（402/517）和66.7%（345/517）。在PI-RADS 4组中，前列腺活检阴性或WHO/ISUP 1、2、3、4或5级组的患者分别占28.2%、12.7%、20.1%、17.1%、18.4%和3.5%，而在PI-RADS 5组中，这些比例分别为7.4%、6.8%、22.3%、22.3%、26.4%和14.9%。差异具有统计学意义（<0.001）。PI-RADS 4组中PCa和CsPCa的检出率[71.8%（265/369）对59.1%（218/369），<0.001]低于PI-RADS 5组[92.6%（137/148）对85.8%（127/148），<0.001]。在PI-RADS 4组中，归类为WHO/ISUP 4 - 5级组的患者比例低于PI-RADS 5组[22.0%（81/369）对41.2%（61/148）（<0.001）]。PSA<10 ng/ml分层中PCa和CsPCa的检出率低于PSA 10 - 20 ng/ml分层[74.1%（281/379）对87.7%（121/138），=0.001]，以及[60.9%（231/379）对82.6%（114/138），<0.001]。对于PSA<10 ng/ml的患者，PI-RADS 4组中PCa和CsPCa的检出率低于PI-RADS 5组[70.9%（217/306）对87.7%（64/73），=0.003]，以及[56.2%（172/306）对80.8%（59/73），<0.001]。对于PSA值为10 - 20 ng/ml的患者，PI-RADS 4组中PCa和CsPCa的检出率低于PI-RADS 5组[76.2%（48/63）对97.3%（73/75），<0.001]，以及[73.0%（46/63）对90.7%（68/75），=0.006]。在两个分层中，PI-RADS 4组和PI-RADS 5组之间前列腺活检阴性患者及WHO/ISUP 1、2、3、4或5级组患者的比例存在统计学显著差异（<0.001）。在本研究中，PI-RADS 4组中CsPCa和PCa的检出率低于PI-RADS 5组。随着PI-RADS评分增加，高级别PCa的检出率升高。PSA<10 ng/ml或PSA 10 - 20 ng/ml的患者也有相同结果。
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