PRECISE 版本 2：前列腺癌主动监测患者前列腺磁共振成像报告的更新建议。
PRECISE Version 2: Updated Recommendations for Reporting Prostate Magnetic Resonance Imaging in Patients on Active Surveillance for Prostate Cancer.
机构信息
Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK.
Division of Surgery & Interventional Science, University College London, London, UK; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK.
出版信息
Eur Urol. 2024 Sep;86(3):240-255. doi: 10.1016/j.eururo.2024.03.014. Epub 2024 Mar 30.
BACKGROUND AND OBJECTIVE
The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations standardise the reporting of prostate magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer. An international consensus group recently updated these recommendations and identified the areas of uncertainty.
METHODS
A panel of 38 experts used the formal RAND/UCLA Appropriateness Method consensus methodology. Panellists scored 193 statements using a 1-9 agreement scale, where 9 means full agreement. A summary of agreement, uncertainty, or disagreement (derived from the group median score) and consensus (determined using the Interpercentile Range Adjusted for Symmetry method) was calculated for each statement and presented for discussion before individual rescoring.
KEY FINDINGS AND LIMITATIONS
Participants agreed that MRI scans must meet a minimum image quality standard (median 9) or be given a score of 'X' for insufficient quality. The current scan should be compared with both baseline and previous scans (median 9), with the PRECISE score being the maximum from any lesion (median 8). PRECISE 3 (stable MRI) was subdivided into 3-V (visible) and 3-NonV (nonvisible) disease (median 9). Prostate Imaging Reporting and Data System/Likert ≥3 lesions should be measured on T2-weighted imaging, using other sequences to aid in the identification (median 8), and whenever possible, reported pictorially (diagrams, screenshots, or contours; median 9). There was no consensus on how to measure tumour size. More research is needed to determine a significant size increase (median 9). PRECISE 5 was clarified as progression to stage ≥T3a (median 9).
CONCLUSIONS AND CLINICAL IMPLICATIONS
The updated PRECISE recommendations reflect expert consensus opinion on minimal standards and reporting criteria for prostate MRI in AS.
背景与目的
前列腺癌影像学变化连续评估（PRECISE）推荐标准规范了对接受主动监测（AS）的前列腺癌患者进行前列腺磁共振成像（MRI）的报告。最近，一个国际共识小组更新了这些建议，并确定了存在不确定性的领域。
方法
一个由 38 名专家组成的小组使用了正式的 RAND/UCLA 适宜性方法共识方法。小组成员使用 1-9 的同意量表对 193 个陈述进行评分，其中 9 表示完全同意。对每个陈述进行了一致性、不确定性或分歧（根据小组中位数评分得出）和共识（使用对称性调整的百分位数范围方法确定）的总结，并在重新评分之前进行了讨论。
主要发现和局限性
参与者一致认为 MRI 扫描必须满足最低图像质量标准（中位数 9），或者图像质量不足得分为“X”。当前扫描必须与基线和以前的扫描进行比较（中位数 9），PRECISE 评分是任何病变的最大值（中位数 8）。PRECISE 3（稳定的 MRI）进一步细分为 3-V（可见）和 3-NonV（不可见）疾病（中位数 9）。前列腺成像报告和数据系统/李克特≥3 个病变应在 T2 加权成像上进行测量，使用其他序列辅助识别（中位数 8），并在可能的情况下进行图像报告（图表、屏幕截图或轮廓；中位数 9）。对于如何测量肿瘤大小，没有达成共识。需要更多的研究来确定显著的大小增加（中位数 9）。PRECISE 5 被澄清为进展到≥T3a 期（中位数 9）。
结论和临床意义
更新的 PRECISE 建议反映了专家对 AS 中前列腺 MRI 的最小标准和报告标准的共识意见。
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