Qin Fei, Wu Jingyun, Ma Jianguo, Tian Shaojuan, Li Derun, Chen Shuyuan, Liu Yi, Li Xuesong
Peking University First Hospital, Beijing, China.
The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Abdom Radiol (NY). 2025 Apr 12. doi: 10.1007/s00261-025-04903-1.
To develop and validate a novel ultrasound scoring system (USS) for assisting cognitive fusion-targeted biopsy (cTB).
We prospectively collected a study cohort consisting of 452 patients with biopsy-naïve, PSA ≤ 20 ng/ml and their 531 Prostate Imaging Reporting and Data System (PI-RADS) v2.1 ≥ 3 lesions. All MRI regions of interest were scored as USS 0, 1, 2, and 3 for the corresponding lesion or region on TRUS. The cumulative cancer detection rate of the biopsy cores was assessed according to USS. Subgroup analysis was conducted to assess the csPCa detection rate following the re-stratification of PI-RADS using USS. Receiver operating characteristics (ROC) analysis was performed for USS, PI-RADS and USS + PI-RADS. The area under the curve (AUC), sensitivity, and specificity were calculated at the cut-off selected by the Youden index.
The overall cancer detection rates for USS scores of 0 to 3 were 0% (0/67), 66% (111/166), 83% (176/210), and 100% (59/59), respectively. For USS 2 and USS 3 lesions, the detection rates in targeting the 3rd core (79%, P = 0.774) and 2nd core (93%, P = 0.125) did not significantly increase with subsequent biopsy cores. In the subgroup analysis, the csPCa positive rate for USS 0 was zero across all PI-RADS categories. In contrast, USS 1, 2, and 3 enhanced the csPCa positive rate within each PI-RADS strata. In ROC analysis, the AUC (95% CI) for the combined USS + PI-RADS 0.85 (0.82-0.89) outperformed PI-RADS 0.77 (0.73-0.81) alone (P < 0.001). USS + PI-RADS sensitivity (95% CI) was 80.7% (75.6-84.9) compared to PI-RADS 72.5% (67.6-77.0).
In cTB, USS has good performance in cancer risk re-stratification, with higher USS scores correlating with an increased likelihood of cancer and improved diagnostic accuracy.
No. 2023-272-002, July 14, 2023.
开发并验证一种新型超声评分系统（USS），以辅助认知融合靶向活检（cTB）。
我们前瞻性收集了一个研究队列，该队列由452例未经活检、前列腺特异性抗原（PSA）≤20 ng/ml且有531个前列腺影像报告和数据系统（PI-RADS）v2.1≥3级病变的患者组成。所有磁共振成像（MRI）感兴趣区域根据超声检查（TRUS）上相应病变或区域被评为USS 0、1、2和3级。根据USS评估活检组织芯的累积癌症检出率。进行亚组分析以评估使用USS对PI-RADS重新分层后的临床显著前列腺癌（csPCa）检出率。对USS、PI-RADS以及USS + PI-RADS进行受试者操作特征（ROC）分析。在约登指数选定的临界值处计算曲线下面积（AUC）、敏感性和特异性。
USS评分为0至3时的总体癌症检出率分别为0%（0/67）、66%（111/166）、83%（176/210）和100%（59/59）。对于USS 2级和USS 3级病变，靶向第3个组织芯（79%，P = 0.774）和第2个组织芯（93%，P = 0.125）时的检出率，随着后续活检组织芯并未显著增加。在亚组分析中，所有PI-RADS类别中USS 0级的csPCa阳性率均为零。相比之下，USS 1级、2级和3级提高了各PI-RADS分层内的csPCa阳性率。在ROC分析中，联合USS + PI-RADS的AUC（95%可信区间）为0.85（0.82 - 0.89），优于单独的PI-RADS 0.77（0.73 - 0.81）（P < 0.001）。USS + PI-RADS的敏感性（95%可信区间）为80.7%（75.6 - 84.9），而PI-RADS为72.5%（67.6 - 77.0）。
在cTB中，USS在癌症风险重新分层方面表现良好，USS评分越高，癌症可能性增加且诊断准确性提高。
编号2023 - 272 - 002，2023年7月14日。
