Ivey Michael C, Deivasigamani Sriram, Kotamarti Srinath, Mottaghi Mahdi, Ghoreifi Alireza, Adams Eric S, Jhaveri Hasan, Robertson Cary N, Kruse Danielle E, Kalisz Kevin R, Marin Daniele, Thomas Sarah P, Polascik Thomas J, Gupta Rajan T
Department of Radiology, DUMC Box 3808, Durham, NC, 27710, USA.
Duke Cancer Institute Center for Prostate and Urologic Cancers, DUMC Box 103861, 20 Duke Medicine Circle, Durham, NC, 27710, USA.
Eur Radiol. 2025 Apr 2. doi: 10.1007/s00330-025-11513-4.
The efficacy of focal therapy (FT) has improved with the use of multiparametric MRI (mpMRI) for lesion identification, though standardized mpMRI reporting post-FT is lacking. The Prostate Imaging after Focal Ablation (PI-FAB) scoring system was recently introduced to standardize mpMRI interpretation for local recurrence post-FT. This study evaluates the diagnostic performance and inter-reader reliability of PI-FAB following cryoablation and high-intensity focused ultrasound (HIFU) modalities.
This retrospective, single-institution study included all patients treated with FT from 2007 to 2023 with available follow-up mpMRI and subsequent prostate biopsy. Three fellowship-trained radiologists scored these images using the PI-FAB system. The primary objective was inter-reader agreeability of PI-FAB scores, and the secondary objective assessed performance metrics, including sensitivity, specificity, positive predictive and negative predictive value.
91 patients with 113 mpMRI exams (95 post-cryotherapy; 18 post-HIFU) were reviewed. There was substantial agreement between the readers (Fleiss' Kappa (κ): 0.71, p < 0.001; Gwet AC2: 0.70, p < 0.03). A PI-FAB score 3 had a significant ability to rule-in csPCa with high specificity (88%, 86%, and 93% per reader, respectively), and PI-FAB score 1 had high sensitivity to rule out csPCa (88%, 78%, and 84% per reader, respectively) in surveillance imaging (14-16 months median follow-up).
Our study suggests that the PI-FAB scoring system can be effectively used to evaluate mpMRI recurrence post-FT, with substantial inter-reader reliability and high specificity for predicting in-field clinically significant prostate cancer recurrence post-cryotherapy and HIFU. Larger, multi-institutional studies are essential to confirm PI-FAB's utility in clinical practice.
Question There is no widely accepted and validated standardized scoring system to predict the local recurrence of clinically significant prostate cancer after focal therapy with ablative modalities. Findings The Prostate Imaging after Focal Ablation (PI-FAB) scoring system effectively predicts in-field recurrence of prostate cancer after focal therapy with substantial inter-reader reliability and specificity. Clinical relevance As patient requests for focal therapy to treat localized low- to- intermediate risk prostate cancer become more common, based on its performance metrics, PI-FAB will aid in identifying in-field recurrence within this patient population.
尽管缺乏聚焦治疗（FT）后标准化的多参数MRI（mpMRI）报告，但使用mpMRI进行病变识别已提高了FT的疗效。最近引入了聚焦消融后前列腺成像（PI-FAB）评分系统，以标准化FT后局部复发的mpMRI解读。本研究评估了冷冻消融和高强度聚焦超声（HIFU）治疗后PI-FAB的诊断性能和阅片者间可靠性。
这项回顾性单机构研究纳入了2007年至2023年接受FT治疗且有可用随访mpMRI及后续前列腺活检的所有患者。三位经过专科培训的放射科医生使用PI-FAB系统对这些图像进行评分。主要目标是PI-FAB评分的阅片者间一致性，次要目标是评估性能指标，包括敏感性、特异性、阳性预测值和阴性预测值。
回顾了91例患者的113次mpMRI检查（95次冷冻治疗后；18次HIFU治疗后）。阅片者之间存在高度一致性（Fleiss' Kappa（κ）：0.71，p < 0.001；Gwet AC2：0.70，p < 0.03）。PI-FAB评分为3对临床显著性前列腺癌（csPCa）具有显著的高特异性诊断能力（每位阅片者分别为88%、86%和93%），而PI-FAB评分为1在监测成像（中位随访14 - 16个月）中对排除csPCa具有高敏感性（每位阅片者分别为88%、78%和84%）。
我们的研究表明，PI-FAB评分系统可有效用于评估FT后的mpMRI复发情况，阅片者间可靠性高，对预测冷冻消融和HIFU治疗后前列腺内临床显著性癌症复发具有高特异性。更大规模的多机构研究对于确认PI-FAB在临床实践中的效用至关重要。
问题：目前尚无广泛接受且经过验证的标准化评分系统来预测消融性聚焦治疗后临床显著性前列腺癌的局部复发。研究结果：聚焦消融后前列腺成像（PI-FAB）评分系统能有效预测聚焦治疗后前列腺内复发情况，阅片者间可靠性和特异性高。临床意义：随着患者对聚焦治疗局限性低至中度风险前列腺癌的需求日益普遍，基于其性能指标，PI-FAB将有助于识别该患者群体中的前列腺内复发情况。
