能否依靠磁共振成像进行前列腺癌检测和手术规划？经会阴靶向穿刺活检的大样本患者综合分析。

Can we rely on magnetic resonance imaging for prostate cancer detection and surgical planning? Comprehensive analysis of a large cohort of patients undergoing transperineal mapped biopsies.

机构信息

Urology Department. Urosalud. La Salud Hospital, Valencia, 46021, Spain.

Urology Department, Valencian Institute of Oncology Foundation (FIVO), Valencia, 46009, Spain.

出版信息

World J Urol. 2024 Sep 30;42(1):548. doi: 10.1007/s00345-024-05233-5.

DOI:10.1007/s00345-024-05233-5

PMID:39347947

Abstract

PURPOSE

To evaluate MRI and histological concordance in prostate cancer (PCa) identification via mapped transperineal biopsies.

METHODOLOGY

Retrospective per-lesion analysis of patients undergoing MRI and transperineal biopsy at the Valencian Institute of Oncology (2016-2024) using CAPROSIVO PCa data. Patients underwent MRI, with or without regions of interest (ROI), followed by transperineal biopsies (3-5 cores/ROI, 20-30 systematic). Sensitivity (Se), specificity (Sp), negative predictive value (NPV), positive predictive value (PPV), and area under the curve (AUC) were calculated, considering PI-RADS 3 lesions as positive or negative. Gleason Grade Group (GG) > 1 defined clinically significant PCa (csPCa).

RESULTS

1817 lesions were analyzed from 1325 patients (median age 67, median PSA 6.3 ng/ml). 53% MRI were negative, GG > 1 prevalence was 38.4%. MRI-negative cases showed varying PCa rates: 57.4% negative, 30.2% GG 1, and 12.4% GG > 1. PI-RADS 3 lesions had mixed outcomes: 45.6% benign, 13.1% GG 1, and 41.3% GG > 1. 9.2% PI-RADS 4-5 lesions were negative, 9% GG 1, and 81.7% GG > 1. For PI-RADS 3 lesions considered positive, Se, Sp, NPV, PPV, and AUC were 82.9%, 75%, 87.6%, 67.4%, and 0.79 respectively. Considering PI-RADS 3 as negative yielded 64.8% Se, 91% Sp, 80.6% NPV, 81.7% PPV, and 0.78 AUC.

CONCLUSION

MRI and mapped prostate biopsies exhibited moderate concordance. MRI could miss up to one in five csPCa foci and misinterpret one in three ROIs. Careful MRI interpretation is crucial for optimizing patient care.

摘要

目的

通过经会阴映射活检评估 MRI 与前列腺癌（PCa）识别的一致性。

方法

对 2016 年至 2024 年期间在瓦伦西亚肿瘤研究所接受 MRI 和经会阴活检的患者进行回顾性每病灶分析，使用 CAPROSIVO PCa 数据。患者行 MRI 检查，可联合或不联合感兴趣区（ROI），随后进行经会阴活检（每 ROI 3-5 针，共 20-30 针系统性活检）。考虑 PI-RADS 3 病变为阳性或阴性，计算灵敏度（Se）、特异性（Sp）、阴性预测值（NPV）、阳性预测值（PPV）和曲线下面积（AUC）。GG＞1 定义为有临床意义的 PCa（csPCa）。

结果

共分析了 1325 例患者的 1817 个病灶（中位年龄 67 岁，中位 PSA 6.3ng/ml）。53%的 MRI 为阴性，GG＞1 的患病率为 38.4%。MRI 阴性病例的 PCa 检出率各不相同：57.4%阴性，30.2%GG1，12.4%GG＞1。PI-RADS 3 病变的结果也各不相同：45.6%良性，13.1%GG1，41.3%GG＞1。9.2%的 PI-RADS 4-5 病变为阴性，9%GG1，81.7%GG＞1。考虑 PI-RADS 3 为阳性时，Se、Sp、NPV、PPV 和 AUC 分别为 82.9%、75%、87.6%、67.4%和 0.79。将 PI-RADS 3 考虑为阴性时，Se 为 64.8%，Sp 为 91%，NPV 为 80.6%，PPV 为 81.7%，AUC 为 0.78。