前列腺成像报告和数据系统与活检证实的前列腺癌根治术后患者临床及病理学特征比较

Prostate imaging reporting and data system (PI-RADS) for assessment of pathologic outcomes and clinical characteristics in patients with prostate cancer confirmed by biopsy

目的探讨前列腺成像报告和数据系统(PI-RADS)与活检证实的前列腺癌(PCa)根治术后患者临床及病理学特征。方法回顾性分析2013年1月至2017年6月行多参数磁共振(mp MRI)检查PCa患者,筛选81例经直肠超声介导下穿刺活检证实PCa评分GS 3+4=7并行根治术PCa患者作为研究对象。有2位放射科医师采用双盲法评价MR图像,并根据PI-RADS标准对病灶进行评分(1~5分),然后比较PI-RADS评分与PCa根治术后病灶GS、有无包膜外扩散之间的关系。结果 53.1%(43/81)穿刺活检证实GS 3+4=7 PCa根治术后证实有包膜外扩散,2.5%(2/81)GS降级为GS 3+3=6,21.0%(17/81)GS升级到GS 4+3=7。PI-RADS诊断GS 4+3≥7 PCa具有中度精确性(AUC,0.65;95%CI,0.54~0.77),诊断包膜外扩散AUC值是0.72(95%CI,0.62~0.87)。PI-RADS3分或3分以上对诊断GS 4+3≥7 PCa敏感度为100.0%。PI-RADS 4分或以上诊断PCa敏感度和特异度分别为94.1%和23.4%。不同医师之间评价为中度一致性(κ=0.43)。结论经直肠超声穿刺活检证实GS 3+4=7 PCa根治术后,较高PI-RADS评分与病理升级到GS 4+3=7、有包膜外扩散密切相关。

Objective To explore the prostate imaging reporting and data system （PI-RADS） forassessment of pathologic outcomes and clinical characteristics after radical prostatectomy （ RP ） whoconfirmed by biopsy.Methods The patients who underwent multiple parameter MRI （mpMRI） and werediagnosed by prostate cancer （ PCa） from January 2013 to June 2017 were reviewed retrospectively. Ofwhich,81 patients were screened after RP in patients with GS 3 ＋ 4 = 7 tumor at biopsy. Two radiologistsassessed mpMRI with double blind method and assigned PI-RADS categories （ categories 1 ～ 5）, whichcompared to the GS, and the presence of extracapsular extension （ ECE） after RP. Results 53. 1% ofpatients （43 / 81） had ECE,and 2.5% （2 / 81） had their tumors downgraded to GS 3＋3 = 6,whereas 21.0%（17 / 81） had GS 4＋3 = 7 PCa after RP.PI-RADS showed moderate accuracy for the diagnosis of GS 4＋3≥7tumors （AUC,0.65;95% CI,0.54～ 0.77） and moderate accuracy for the ECE （AUC,0.72;95%CI,0.62 ～0.87）.The sensitivity of PI-RADS score of 3 or higher was 100% for diagnosis of GS 4＋3 = 7 PCa.PI-RADScategory of 4 or higher for diagnosis of PCa were 94.1% and 23.4%,respectively.Interobserver agreement was moderate （κ = 0.43）.Conclusion For GS 3＋4 = 7 cancers detected at biopsy,higher PI-RADS categoriesare associated with upgrading to GS 4＋3 = 7 and the presence of ECE after RP.