Jin Yongming, Chen Fei, Xu Gang, Wei Chaogang, Dong Congsong
Department of Radiology, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng Third People's Hospital, Yancheng, China.
Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China.
Sci Rep. 2025 Jan 25;15(1):3258. doi: 10.1038/s41598-025-87311-1.
We intended to investigate the potential of several transitional zone (TZ) volume-related variables for the detection of clinically significant prostate cancer (csPCa) among lesions scored as Prostate Imaging Reporting and Data System (PI-RADS) category 3. Between September 2018 and August 2023, patients who underwent mpMRI examination and scored as PI-RADS 3 were queried from our institution. The diagnostic performances of prostate-specific antigen density (PSAD), TZ-adjusted PSAD (TZPSAD), and TZ-ratio (TZ volume/whole gland prostate volume) were analyzed. We calculated the sensitivity and specificity for each variable, the overall accuracy was evaluated with the area under the receiver operating characteristic curve (AUC). The best cutoff value was determined by the Youden index, and differences between diagnostic performances were compared with the Delong test. A total of 154 TZ lesions were included, of them 28 were diagnosed with csPCa. The AUC for PSAD, TZPSAD, and TZ-ratio were 0.644 (95% CI 0.538-0.751), 0.714 (95% CI 0.607-0.821), and 0.746 (95% CI 0.636-0.856), with corresponding optimal cutoff values of 0.11 ng/ml/ml, 0.21 ng/ml/ml, and 0.66 ng/ml/ml, respectively. PSAD was significantly inferior to either TZPSAD (P = 0.03) or TZ-ratio (P = 0.03). The combination model including TZPSAD, TZ-ratio, and age generated an AUC of 0.838 (95% CI 0.759-0.917), significantly higher than use of these variables alone, with P values of 0.001 and 0.035 for the TZPSAD and TZ-ratio, respectively. TZPSAD and TZ-ratio were found to be independent predictors for differentiating csPCa among TZ lesions categorized as PI-RADS score 3. Furthermore, by combining these two variables with others, the diagnostic performance can be improved significantly.
我们旨在研究几个与移行区（TZ）体积相关的变量在检测前列腺影像报告和数据系统（PI-RADS）分类为3类的病变中具有临床意义的前列腺癌（csPCa）的潜力。在2018年9月至2023年8月期间，从我们机构查询接受多参数磁共振成像（mpMRI）检查且PI-RADS评分为3分的患者。分析了前列腺特异性抗原密度（PSAD）、经TZ校正的PSAD（TZPSAD）和TZ比值（TZ体积/前列腺总体积）的诊断性能。我们计算了每个变量的敏感性和特异性，通过受试者工作特征曲线下面积（AUC）评估总体准确性。通过约登指数确定最佳临界值，并使用德龙检验比较诊断性能之间的差异。共纳入154个TZ病变，其中28个被诊断为csPCa。PSAD、TZPSAD和TZ比值的AUC分别为0.644（95%CI 0.538 - 0.751）、0.714（95%CI 0.607 - 0.821）和0.746（95%CI 0.636 - 0.856），相应的最佳临界值分别为0.11 ng/ml/ml、0.21 ng/ml/ml和0.66 ng/ml/ml。PSAD明显低于TZPSAD（P = 0.03）或TZ比值（P = 0.03）。包括TZPSAD、TZ比值和年龄的联合模型产生的AUC为0.838（95%CI 0.759 - 0.917），显著高于单独使用这些变量，TZPSAD和TZ比值的P值分别为0.001和0.035。发现TZPSAD和TZ比值是区分PI-RADS评分为3分的TZ病变中csPCa的独立预测因素。此外，通过将这两个变量与其他变量相结合，诊断性能可显著提高。
