Yi Ying, Chen Zhiyin, Wang Hang, Cheng Dongliang, Luo Chun, Zhao Hai
First People`s Hospital of Foshan, Foshan, China.
The Second People`s Hospital of Foshan, Foshan, China.
Abdom Radiol (NY). 2025 May 3. doi: 10.1007/s00261-025-04974-0.
To develop and validate a biparametric magnetic resonance imaging(BpMRI) focused model for detecting clinically significant prostate cancer(csPCa)( Gleason score ≥ 7) in TZ PI-RADS 3 and 4 lesions, compared to the Risk-based model (PI-RADS ≥ 3 and PSA density (PSAD) ≥ 0.15 ng/ml/cm³).
A multi-center, retrospective cohort analysis was conducted on consecutive patients with PI-RADS 3 or 4 and eligible biopsy result. Multivariable logistic regression identified predictors of csPCa, followed by the areas under the curve(AUC) and decision curve analysis (DCA) comparisons between the Risk-based and BpMRI focused models, with external validation.
A total of 121 patients with 231 lesions in the development cohort(cohort 1) and 45 patients with 81 lesions the external validation cohort(cohort 2) were included between January 2020 and December 2024. The AUCs of the BpMRI-focused model were higher than those of the risk-based model in both the development cohort (0.71 [95% CI: 0.62-0.81] vs. 0.83 [95% CI: 0.74-0.92], p < 0.05) and the external validation cohort (0.75 [95% CI: 0.63-0.87] vs. 0.87 [95% CI: 0.79-0.95], p < 0.05). Furthermore, the BpMRI Focused Model significantly reduced the number of false positives for clinically significant prostate cancer compared to the Risk-Based Model [54 (23%) vs. 142 (61%), p < 0.002], while maintaining a cancer detection rate comparable to the PI-RADS ≥ 3 strategy (both p > 0.05). Additionally, the BpMRI Focused Model achieved a higher biopsy avoidance rate for csPCa [15 (6%)] compared to the Risk-Based Model [10 (4%)], though the difference was not statistically significant (p = 0.30).
In clinical decision-making, lesions in the TZ with PI-RADS 3 or 4 can be incorporated into the BpMRI focused model to reduce unnecessary biopsies.
开发并验证一种双参数磁共振成像（BpMRI）聚焦模型，用于检测移行带（TZ）中PI-RADS 3和4类病变中的临床显著性前列腺癌（csPCa）（Gleason评分≥7），并与基于风险的模型（PI-RADS≥3且前列腺特异抗原密度（PSAD）≥0.15 ng/ml/cm³）进行比较。
对连续的PI-RADS 3或4类且活检结果符合条件的患者进行多中心回顾性队列分析。多变量逻辑回归确定csPCa的预测因素，随后对基于风险的模型和BpMRI聚焦模型进行曲线下面积（AUC）和决策曲线分析（DCA）比较，并进行外部验证。
在2020年1月至2024年12月期间，纳入了121例患者的231个病变作为开发队列（队列1），以及45例患者的81个病变作为外部验证队列（队列2）。在开发队列中，BpMRI聚焦模型的AUC高于基于风险的模型（0.71 [95%置信区间：0.62 - 0.81] 对 0.83 [95%置信区间：0.74 - 0.92]，p < 0.05）；在外部验证队列中也是如此（0.75 [95%置信区间：0.63 - 0.87] 对 0.87 [95%置信区间：0.79 - 0.95]，p < 0.05）。此外，与基于风险的模型相比，BpMRI聚焦模型显著减少了临床显著性前列腺癌的假阳性数量[54（23%）对142（61%），p < 0.002]，同时保持了与PI-RADS≥3策略相当的癌症检测率（两者p > 0.05）。另外，与基于风险的模型[10（4%）]相比，BpMRI聚焦模型实现了更高的csPCa活检避免率[15（6%）]，尽管差异无统计学意义（p = 0.30）。
在临床决策中，PI-RADS 3或4类的TZ病变可纳入BpMRI聚焦模型，以减少不必要的活检。
