不同专业影像医生采用PI-RADS评分诊断有临床意义前列腺癌的差异性研究

Comparison of the diagnostic accuracy of clinically significant prostate cancer based on the PI-RADS:an interobserver study

目的比较全科影像医生和泌尿影像医生基于前列腺影像报告和数据系统(PI—RADS)诊断有临床意义前列腺癌的差异。方法回顾性分析2015年8月至2018年2月北京和睦家医院45例行前列腺多参数核磁(mpMRI)检查以及核磁靶向认知融合前列腺穿刺患者的临床资料。年龄(60.0±8.0岁),前列腺特异性抗原(PSA)中位值7.2ng/ml(1.2~95.8ng/ml),前列腺体积中位值45.0ml(18.3~127.0ml)。由北京和睦家医院全科影像医生根据PI-RADS 2.0进行诊断和PI—RADS评分。之后由首都医科大学附属北京安贞医院1名高年资主治泌尿影像医生单盲重新阅片,同样根据PI—RADS 2.0进行评分。PI-RADS≥3分的患者怀疑有临床意义前列腺癌。分析全科影像医生和泌尿影像医生对前列腺癌,尤其是有临床意义前列腺癌诊断的准确性及阳性预测价值(PPV)。结果全科影像医生诊断PI—RADS评分中位值3.0分,其中1、2、3、4、5分者分别为0、8、19、14、4例。泌尿影像医生诊断PI-RADS评分中位值2,8分,其中1、2、3、4、5分者分别为4、24、5、1、11例,二者的评分分布差异无统计学意义(P=0.064)。45例穿刺病理共检出前列腺癌14例,其中有临床意义前列腺癌9例。全科影像医生诊断PI-RADS≥3分者37例(82.2%),而泌尿影像医生诊断PI—RADS≥3分者17例(37.8%)。二者诊断的一致率仅17.8%(8/45)。全科影像医生和泌尿影像医生诊断PI—RADS≥3分对前列腺癌的PPV分别为35.1%(13/37)和76.5%(13/17),对有临床意义前列腺癌的PPV分别为21.6%(8/37)和52.9%(9/17)。结论泌尿影像医生采用PI—RADS评分对有临床意义前列腺癌的预测价值高于全科影像医生。在有泌尿影像诊断经验的中心可以尝试只对高PI-RADS评分患者进行穿刺活检,以减少不必要穿刺。

Objective To compare the diagnostic accuracy of clinically significant prostate cancer by general radiologist and uroradiology specialist based on the Prostate Imaging Reporting and Data System (PI-RADS).Methods A total of 45 men from Beijing United Family Hospital and Clinics undergoing prostate mpMRI examination and subsequent MRI-targeted biopsy were included in the study.The age of patients was (60.0±8.0)years ,the median PSA level was 7.2ng/ml (1.2-95.8ng/ml)and the median prostate volume was 45.0ml (18.3-127.0ml).The general radiologists from Beijing United Family Hospital and Clinics made the diagnosis according to PI-RADS 2.0.One uroradiology specialist from Beijing Anzhen hospital reviewed all the mpMRIs retrospectively and marked new PI-RADS score based on PI-RADS 2.0.The PI-RADS ≥3lesion was recognized as suspicious of clinically significant prostate cancer.The distribution of PI-RADS score from different doctors and the diagnostic accuracy of clinically significant prostate cancer was compared.Results All the 45 patients underwent MRI-targeted cognitive biopsy and 14 cases of prostate cancer were detected,including 9 cases of clinically significant prostate cancer.There was no significant difference in the distribution of PI-RADS by general radiologist and uroradiology specialist(P = 0.064).82.8%(37/45)and 37.8%(17/45)patients were diagnosed with PI-RADS≥3by general radiologist and uroradiology specialist respectively.The interobserver agreement was only 17.8%(8/45). The positive predictive value of PI-RADS≥3was 35.1%(13/37)and 76.5%(13/17)for prostate cancer by general radiologist and uroradiology specialist respectively,and for clinically significant prostate cancer, the positive predictive value of PI-RADS ≥3was 21.6%(8/37)and 52.9%(9/17)respectively. Conclusions Uroradiology specialist achieved significantly superior in predietive value of PI-RADS for clinically significant prostate cancer compared with general radiologist.In the experienced centers,MRI-targeted biopsy could be performed only on high PI-RADS score lesions ,thus to reduce unnecessary biopsies and to avoid over diagnosis and over treatment of prostate cancer.