Vapnek J M, Hricak H, Shinohara K, Popovich M, Carroll P
Department of Urology, University of California School of Medicine, San Francisco 94143-0738.
Urol Int. 1994;53(4):191-5. doi: 10.1159/000282671.
The present study was undertaken to compare the ability of magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) to identify the presence or absence of extracapsular tumor extension and seminal vesicle involvement in patients with clinically localized (stages A and B, T1-T2) prostatic cancer. Sixty-four patients (ages 44-77 years) underwent radical retropubic prostatectomy and pelvic lymphadenectomy after staging with both MRI and TRUS. Surgical specimens were step-sectioned and examined at multiple levels. Radiographic staging was correlated with pathological staging. Both MRI and TRUS demonstrated better staging accuracy than conventional digital rectal examination [42% for digital rectal examination (DRE), 63% by TRUS, and 67% by MRI], although they suffered from understaging (31% by TRUS and 22% by MRI). The positive predictive value (PPV) for stage B disease was disappointingly low (42% for DRE, 53% for TRUS and 59% for MRI). However, the PPV for stage C disease was higher (81% for TRUS and 77% for MRI). In the evaluation of extracapsular invasion, the PPV of TRUS (81%) was higher than that of MRI (77%). The negative predictive value (NPV), however, for both TRUS and MRI was low (58 and 56%, respectively). In the evaluation of seminal vesicle invasion, both TRUS and MRI demonstrated poor PPV (50 and 40%, respectively), but the NPV was excellent (90% for TRUS and 96% for MRI). MRI failed to detect metastatic lymph nodes in 4 of 6 patients while falsely predicting their presence in 4 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
本研究旨在比较磁共振成像（MRI）和经直肠超声（TRUS）在识别临床局限性（A期和B期，T1 - T2）前列腺癌患者是否存在包膜外肿瘤扩展及精囊受累方面的能力。64例患者（年龄44 - 77岁）在接受MRI和TRUS分期后，进行了耻骨后根治性前列腺切除术和盆腔淋巴结清扫术。手术标本进行连续切片并在多个层面检查。影像学分期与病理分期进行相关性分析。尽管MRI和TRUS均存在分期过低的情况（TRUS为31%，MRI为22%），但二者的分期准确性均优于传统直肠指检[直肠指检（DRE）为42%，TRUS为63%，MRI为67%]。B期疾病的阳性预测值（PPV）令人失望地低（DRE为42%，TRUS为53%，MRI为59%）。然而，C期疾病的PPV较高（TRUS为81%，MRI为77%）。在评估包膜外侵犯时，TRUS的PPV（81%）高于MRI（77%）。然而，TRUS和MRI的阴性预测值（NPV）均较低（分别为58%和56%）。在评估精囊侵犯时，TRUS和MRI的PPV均较差（分别为50%和40%），但NPV极佳（TRUS为90%，MRI为96%）。MRI在6例患者中有4例未能检测到转移淋巴结，同时在4例患者中错误地预测了转移淋巴结的存在。（摘要截断于250字）
