PI-RADs v2评分≤3分患者初次前列腺穿刺时的肿瘤检出情况及相关特征
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摘要
目的探讨前列腺影像报告和数据系统第2版(PI-RADs v2)≤3分患者行前列腺穿刺后的肿瘤检出情况,并分析其临床特征。方法采用回顾性研究的方法,选取2012年1月至2018年7月首都医科大学附属北京友谊医院泌尿外科构建的数据库中491例符合纳入标准的患者。对比分析临床有意义前列腺癌(CSPCa)、临床无意义前列腺癌(CIPCa)以及穿刺阴性患者的相关临床资料,计算多参数磁共振成像(mp-MRI)对于CSPCa的阴性预测值。结果491例患者中,273例患者PI-RADs v2评分小于3分(A组),218例患者PI-RADs v2评分等于3分(B组)。A组患者中,前列腺癌(PCa)检出率为21. 6%(59/273),CSPCa检出率为7. 3%(20/273),CIPCa检出率为14. 2%(39/273),良性(Benign)患者检出率为78. 4%(214/273)。B组患者相应的检出率分别为37. 2%(81/218)、23. 4%(51/218)、13. 8%(30/218)、62. 8%(137/218)。两组患者中检出的CSPCa、CIPCa、Benign患者的前列腺特异性抗原(PSA)、前列腺体积(PV)、前列腺特异性抗原密度(PSAD)、每个患者的阳性针数及每针的肿瘤占比差异均具有统计学意义(P <0. 05)。mp-MRI对于PCa及CSPCa的阴性预测值分别为78%和93%。结论 PI-RADs v2评分≤3分患者中,仍具备一定比率的PCa及CSPCa患者,需综合相关临床指标来决定是否行前列腺穿刺。对于mp-MRI阴性(PI-RADs v2 <3分)患者,若PSAD <0. 20 ng/ml2,其罹患CSPCa的可能性较低。
Objective To analyze prostate cancer detection in biopsy-na? ve patients with PI-RADs v2≤3 and their clinical characteristics. Methods Clinical data of 491 Patients with transrectal ultrasound-guided 24-core biopsy and pre-biopsy multi-parametric magnetic resonance imaging( mp-MRI) in our center from January 2012 to July 2018 were retrospectively analyzed,including clinically significant and insignificant prostate cancer( CSPCa and CIPCa) patients and those with negative biopsy. Negative predictive values( NPV) of mp-MRI regarding CSPCa were calculated. Results 273/491 patients had PI-RADs v2 < 3( group A) and 218/491 patients had PI-RADs v2 = 3( group B),respectively. PCa,CSPCa,CIPCa and benign detection rates: 21. 6%,7. 3% 14. 2% and 78. 4% in group A and 37. 2%,23. 4%,13. 8%,62. 8% in group B. Statistical significance was seen between two groups regarding PSA,PSAD,PV,positive cores per patient and tumor-core percentages as with PCa,CSPCa,CIPCa respectively. NPV of mp-MRI for detection of PCa and CSPCa were 78% and 93%,respectively. Conclusion In patients with PI-RADS≤3,it's necessary to combine several clinical methods to decide whether to perform biopsy. For patients with negative mp-MRI as well as PSAD < 0. 20 ng/ml2,the risk of CSPCa could be low.
Objective To analyze prostate cancer detection in biopsy-na? ve patients with PI-RADs v2≤3 and their clinical characteristics. Methods Clinical data of 491 Patients with transrectal ultrasound-guided 24-core biopsy and pre-biopsy multi-parametric magnetic resonance imaging( mp-MRI) in our center from January 2012 to July 2018 were retrospectively analyzed,including clinically significant and insignificant prostate cancer( CSPCa and CIPCa) patients and those with negative biopsy. Negative predictive values( NPV) of mp-MRI regarding CSPCa were calculated. Results 273/491 patients had PI-RADs v2 < 3( group A) and 218/491 patients had PI-RADs v2 = 3( group B),respectively. PCa,CSPCa,CIPCa and benign detection rates: 21. 6%,7. 3% 14. 2% and 78. 4% in group A and 37. 2%,23. 4%,13. 8%,62. 8% in group B. Statistical significance was seen between two groups regarding PSA,PSAD,PV,positive cores per patient and tumor-core percentages as with PCa,CSPCa,CIPCa respectively. NPV of mp-MRI for detection of PCa and CSPCa were 78% and 93%,respectively. Conclusion In patients with PI-RADS≤3,it's necessary to combine several clinical methods to decide whether to perform biopsy. For patients with negative mp-MRI as well as PSAD < 0. 20 ng/ml2,the risk of CSPCa could be low.
引文
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[10]Washino S,Okochi T,Saito K,et al.Combination of prostate imaging reporting and data system(PI-RADS)score and prostate-specific antigen(PSA)density predicts biopsy outcome in prostate biopsy naive patients[J].BJU Int,2017,119(2):225-233.
[11]Distler FA,Radtke JP,Bonekamp D,et al.The Value of PSA Density in Combination with PI-RADSTM for the Accuracy of Prostate Cancer Prediction[J].J Urol,2017,198(3):575-582.
[2]Mottet N,Bellmunt J,Bolla M,et al.EAU-ESTRO-SIOG Guidelines on Prostate Cancer.Part 1:Screening,Diagnosis,and Local Treatment with Curative Intent[J].Eur Urol,2017,71(4):618-629.
[3]Woo S,Suh CH,Kim SY,et al.Diagnostic Performance of Prostate Imaging Reporting and Data System Version 2 for Detection of Prostate Cancer:A Systematic Review and Diagnostic Meta-analysis[J].Eur Urol,2017,72(2):177-188.
[4]Hofbauer SL,Maxeiner A,Kittner B,et al.Validation of Prostate Imaging Reporting and Data System Version 2 for the Detection of Prostate Cancer[J].J Urol,2018,200(4):767-773.
[5]Zhang Y,Zeng N,Zhu YC,et al.Development and internal validation of PI-RADs v2-based model for clinically significant prostate cancer[J].World J Surg Oncol,2018,16(1):102.
[6]Ploussard G,Epstein JI,Montironi R,et al.The contemporary concept of significant versus insignificant prostate cancer[J].Eur Urol,2011,60(2):291-303.
[7]Oishi M,Shin T,Ohe C,et al.Which Patients with Negative Magnetic Resonance Imaging Can Safely Avoid Biopsy for Prostate Cancer[J]?JUrol,2019,201(2):268-277.
[8]Kasivisvanathan V,Rannikko AS,Borghi M,et al.MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis[J].N Engl J Med,2018,378(19):1767-1777.
[9]Wang RS,Kim EH,Vetter JM,et al.Determination of the Role of Negative Magnetic Resonance Imaging of the Prostate in Clinical Practice:Is Biopsy Still Necessary[J]?Urology,2017,102:190-197.
[10]Washino S,Okochi T,Saito K,et al.Combination of prostate imaging reporting and data system(PI-RADS)score and prostate-specific antigen(PSA)density predicts biopsy outcome in prostate biopsy naive patients[J].BJU Int,2017,119(2):225-233.
[11]Distler FA,Radtke JP,Bonekamp D,et al.The Value of PSA Density in Combination with PI-RADSTM for the Accuracy of Prostate Cancer Prediction[J].J Urol,2017,198(3):575-582.