多参数 MRI 靶向与系统活检在筛状和导管内前列腺癌诊断中的比较。

Comparison of Multiparametric MRI-targeted and Systematic Biopsies for Detection of Cribriform and Intraductal Carcinoma Prostate Cancer.

机构信息

From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G.); Division of Urology (L.K., M.K.) and Division of Anatomic Pathology, Laboratory Medicine & Molecular Diagnostics (M.R.D.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Department of Biostatistics, McMaster University, Hamilton, Canada (G.R.P.); Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada (E.C.B.); Department of Pathology and Laboratory Medicine, London Health Sciences Centre, University of Western Ontario, London, Canada (M.M.); and Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (T.H.v.d.K.).

出版信息

Radiology. 2024 Jul;312(1):e231948. doi: 10.1148/radiol.231948.

DOI:10.1148/radiol.231948

PMID:39012252

Abstract

Background Intraductal carcinoma (IDC) and invasive cribriform (Cr) subtypes of prostate cancer (PCa) are an indication of aggressiveness, but the evidence regarding whether MRI can be used to detect Cr/IDC-pattern PCa is contradictory. Purpose To compare the detection of Cr/IDC-pattern PCa at multiparametric MRI (mpMRI)-targeted biopsy versus systematic biopsy in biopsy-naive men at risk for PCa. Materials and Methods This study was a secondary analysis of a prospective randomized controlled trial that recruited participants with a clinical suspicion of PCa between April 2017 and November 2019 at five centers. Participants were randomized 1:1 to either the MRI arm or the systematic biopsy arm. Targeted biopsy was performed in participants with a Prostate Imaging Reporting and Data System score of at least 3. MRI features were recorded, and biopsy slides and prostatectomy specimens were reviewed for the presence or absence of Cr/IDC histologic patterns. Comparison of Cr/IDC patterns was performed using generalized linear mixed modeling. Results A total of 453 participants were enrolled, with 226 in the systematic biopsy arm (median age, 65 years [IQR, 59-70 years]; 196 biopsies available for assessment) and 227 in the mpMRI-targeted biopsy arm (median age, 67 years [IQR, 60-72 years]; 132 biopsies available for assessment). Identification of Cr/IDC PCa was lower in the systematic biopsy arm compared with the mpMRI arm (31 of 196 biopsies [16%] vs 33 of 132 biopsies [25%]; = .01). No evidence of a difference in mean cancer core length (CCL) (11.3 mm ± 4.4 vs 9.7 mm ± 4.5; = .09), apparent diffusion coefficient (685 µm/sec ± 178 vs 746 µm/sec ± 245; = .52), or dynamic contrast-enhanced positivity (27 [82%] vs 37 [90%]; = .33) for clinically significant PCa (csPCa) was observed between participants with or without Cr/IDC disease in the MRI arm. Cr/IDC-positive histologic patterns overall had a higher mean CCL compared with Cr/IDC-negative csPCa (11.1 mm ± 4.4 vs 9.2 mm ± 4.1; = .009). Conclusion MRI-targeted biopsy showed increased detection of Cr/IDC histologic patterns compared with systematic biopsy. Clinical trial registration no. NCT02936258 © RSNA, 2024 See also the editorial by Scialpi and Martorana in this issue.

摘要

背景前列腺癌（PCa）的导管内癌（IDC）和浸润性筛状（Cr）亚型是侵袭性的标志，但关于 MRI 是否可用于检测 Cr/IDC 型 PCa 的证据存在矛盾。目的比较多参数 MRI（mpMRI）靶向活检与系统活检在有 PCa 风险的初诊男性中对 Cr/IDC 型 PCa 的检出情况。材料与方法本研究是一项前瞻性随机对照试验的二次分析，该试验于 2017 年 4 月至 2019 年 11 月在五个中心招募了有 PCa 临床疑似症状的患者。参与者按 1:1 随机分为 MRI 组或系统活检组。在前列腺影像报告和数据系统评分至少为 3 的患者中进行靶向活检。记录 MRI 特征，并对活检切片和前列腺切除术标本进行评估，以确定是否存在 Cr/IDC 组织学模式。使用广义线性混合模型比较 Cr/IDC 模式。结果共纳入 453 名参与者，系统活检组 226 名（中位年龄 65 岁[IQR，59-70 岁]；可评估的活检标本 196 份），mpMRI 靶向活检组 227 名（中位年龄 67 岁[IQR，60-72 岁]；可评估的活检标本 132 份）。与系统活检组相比，mpMRI 组中 Cr/IDC 型 PCa 的检出率较低（196 份活检中有 31 份[16%]，132 份活检中有 33 份[25%]； =.01）。在有临床意义的 PCa（csPCa）的患者中，平均癌核心长度（CCL）（11.3 mm ± 4.4 比 9.7 mm ± 4.5； =.09）、表观扩散系数（685 µm/sec ± 178 比 746 µm/sec ± 245； =.52）或动态对比增强阳性率（27 [82%]比 37 [90%]； =.33）方面，未见差异。mpMRI 组中，Cr/IDC 阳性组织学模式的平均 CCL 高于 Cr/IDC 阴性 csPCa（11.1 mm ± 4.4 比 9.2 mm ± 4.1； =.009）。结论与系统活检相比，mpMRI 靶向活检可提高 Cr/IDC 组织学模式的检出率。临床试验注册号 NCT02936258 © RSNA，2024 参见本期 Scialpi 和 Martorana 的社论。