Tian Yuxuan, Ruan Mingjian, Liu Yi, Li Derun, Wu Jingyun, Shen Qi, Fan Yu, Jin Jie
Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
Department of Radiology, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Aug 18;56(4):567-574. doi: 10.19723/j.issn.1671-167X.2024.04.004.
To assess the rationality of the maximum lesion diameter of 15 mm in prostate imaging reporting and data system (PI-RADS) as a criterion for upgrading a lesion from category 4 to 5 and improve it to enhance the prediction of clinically significant prostate cancer (csPCa).
In this study, the patients who underwent prostate magnetic resonance imaging (MRI) and prostate biopsy at Peking University First Hospital from 2019 to 2022 as a development cohort, and the patients in 2023 as a validation cohort were reviewed. The localization and maximum diameter of the lesion were fully evaluated. The area under the curve (AUC) and the cut-off value of the maximum diameter of the lesion to predict the detection of csPCa were calculated from the receiver operating characteristics (ROC) curve. Confounding factors were reduced by propensity score matching (PSM). Diagnostic efficacy was compared in the validation cohort.
Of the 589 patients in the development cohort, 358 (60.8%) lesions were located in the peripheral zone and 231 (39.2%) were located in the transition zone, and 496 (84.2%) patients detected csPCa. The median diameter of the lesions in the peripheral zone was smaller than that in the transition zone (14 mm . 19 mm, < 0.001). In the ROC analysis of the maximal diameter on the csPCa prediction, there was no statistically significant difference between the peri-pheral zone (AUC=0.709) and the transition zone (AUC=0.673, =0.585), and the cut-off values were calculated to be 11.5 mm for the peripheral zone and 16.5 mm for the migrating zone. By calcula-ting the Youden index for the cut-off values in the validation cohort, we found that the categorisation by lesion location led to better predictive results. Finally, the net reclassification index (NRI) was 0.170.
15 mm as a criterion for upgrading the PI-RADS score from 4 to 5 is reasonable but too general. The cut-off value for peripheral zone lesions is smaller than that in transitional zone. In the future consideration could be given to setting separate cut-off values for lesions in different locations.
评估前列腺影像报告和数据系统（PI-RADS）中15 mm的最大病灶直径作为将病灶从4类升级为5类的标准是否合理，并对其进行改进以增强对临床显著性前列腺癌（csPCa）的预测。
本研究回顾了2019年至2022年在北京大学第一医院接受前列腺磁共振成像（MRI）和前列腺活检的患者作为开发队列，以及2023年的患者作为验证队列。对病灶的定位和最大直径进行了全面评估。根据受试者工作特征（ROC）曲线计算预测csPCa检测的病灶最大直径的曲线下面积（AUC）和临界值。通过倾向评分匹配（PSM）减少混杂因素。在验证队列中比较诊断效能。
在开发队列的589例患者中，358例（60.8%）病灶位于外周带，231例（39.2%）位于移行带，496例（84.2%）患者检测到csPCa。外周带病灶的中位直径小于移行带（14 mm对19 mm，P<0.001）。在对csPCa预测的最大直径的ROC分析中，外周带（AUC=0.709）和移行带（AUC=0.673，P=0.585）之间无统计学显著差异，外周带的临界值计算为11.5 mm，移行带为16.5 mm。通过计算验证队列中临界值的约登指数，我们发现按病灶位置分类可获得更好的预测结果。最后，净重新分类指数（NRI）为0.170。
15 mm作为将PI-RADS评分从4分升级到5分的标准是合理的，但过于笼统。外周带病灶的临界值小于移行带。未来可考虑为不同位置的病灶设置单独的临界值。
