From the Department of Radiology (N.S., Y.N., A.R.H., S.P., T.A.M.), Department of Surgery, Division of Urology (N.S., R.H.B., C.M.), and Department of Anatomical Pathology (T.A.F.), The University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Rm C1, Ottawa, ON, Canada K1Y 4E9; and the Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada (T.R.).
Radiology. 2024 Jun;311(3):e231383. doi: 10.1148/radiol.231383.
Background Biparametric MRI (bpMRI) of the prostate is an alternative to multiparametric MRI (mpMRI), with lower cost and increased accessibility. Studies investigating the positive predictive value (PPV) of bpMRI-directed compared with mpMRI-directed targeted biopsy are lacking in the literature. Purpose To compare the PPVs of bpMRI-directed and mpMRI-directed targeted prostate biopsies. Materials and Methods This retrospective cross-sectional study evaluated men who underwent bpMRI-directed or mpMRI-directed transrectal US (TRUS)-guided targeted prostate biopsy at a single institution from January 2015 to December 2022. The PPVs for any prostate cancer (PCa) and clinically significant PCa (International Society of Urological Pathology grade ≥2) were calculated for bpMRI and mpMRI using mixed-effects logistic regression modeling. Results A total of 1538 patients (mean age, 67 years ± 8 [SD]) with 1860 lesions underwent bpMRI-directed (55%, 849 of 1538) or mpMRI-directed (45%, 689 of 1538) prostate biopsy. When adjusted for the number of lesions and Prostate Imaging Reporting and Data System (PI-RADS) score, there was no difference in PPVs for any PCa or clinically significant PCa ( = .61 and .97, respectively) with bpMRI-directed (55% [95% CI: 51, 59] and 34% [95% CI: 30, 38], respectively) or mpMRI-directed (56% [95% CI: 52, 61] and 34% [95% CI: 30, 39], respectively) TRUS-guided targeted biopsy. PPVs for any PCa and clinically significant PCa stratified according to clinical indication were as follows: biopsy-naive men, 64% (95% CI: 59, 69) and 43% (95% CI: 39, 48) for bpMRI, 67% (95% CI: 59, 75) and 51% (95% CI: 43, 59) for mpMRI ( = .65 and .26, respectively); and active surveillance, 59% (95% CI: 49, 69) and 30% (95% CI: 22, 39) for bpMRI, 73% (95% CI: 65, 89) and 38% (95% CI: 31, 47) for mpMRI ( = .04 and .23, respectively). Conclusion There was no evidence of a difference in PPV for clinically significant PCa between bpMRI- and mpMRI-directed TRUS-guided targeted biopsy. © RSNA, 2024 .
背景 前列腺双参数 MRI（bpMRI）是多参数 MRI（mpMRI）的替代方法，其成本更低，且更易于获得。目前缺乏关于 bpMRI 指导与 mpMRI 指导靶向活检的阳性预测值（PPV）的研究。目的 比较 bpMRI 指导与 mpMRI 指导靶向前列腺活检的 PPV。材料与方法 本回顾性横断面研究评估了 2015 年 1 月至 2022 年 12 月在一家机构接受 bpMRI 指导或 mpMRI 指导经直肠超声（TRUS）引导靶向前列腺活检的男性。使用混合效应逻辑回归模型计算 bpMRI 和 mpMRI 指导的靶向前列腺活检的任何前列腺癌（PCa）和临床显著 PCa（国际泌尿病理学会分级≥2）的 PPV。结果 共有 1538 名患者（平均年龄 67 岁±8[标准差]），1860 个病灶接受了 bpMRI 指导（55%，849/1538）或 mpMRI 指导（45%，689/1538）的前列腺活检。在调整病灶数量和前列腺影像报告和数据系统（PI-RADS）评分后，bpMRI 指导（55%[95%CI：51，59]和 34%[95%CI：30，38]）或 mpMRI 指导（56%[95%CI：52，61]和 34%[95%CI：30，39]）TRUS 引导的靶向活检的任何 PCa 和临床显著 PCa 的 PPV 无差异（ =.61 和.97，分别）。根据临床指征对任何 PCa 和临床显著 PCa 进行分层的 PPV 如下：活检初治男性，bpMRI 为 64%（95%CI：59，69）和 43%（95%CI：39，48），mpMRI 为 67%（95%CI：59，75）和 51%（95%CI：43，59）（ =.65 和.26，分别）；主动监测，bpMRI 为 59%（95%CI：49，69）和 30%（95%CI：22，39），mpMRI 为 73%（95%CI：65，89）和 38%（95%CI：31，47）（ =.04 和.23，分别）。结论 bpMRI 指导与 mpMRI 指导 TRUS 引导靶向活检的临床显著 PCa 的 PPV 之间没有证据表明存在差异。 © RSNA，2024 年。
