第2版前列腺影像报告和数据系统多参数MRI对前列腺癌漏诊及误诊的分析

Missed Diagnosis and Misdiagnosis of Prostate Cancer Based on Prostate Imaging Reporting and Data System version 2 Multi-parametric MRI

目的为提高前列腺临床显著癌的检出率和诊断准确性,第2版前列腺影像报告和数据系统(PI-RADS v2)对多参数MRI(mp-MRI)评估分类标准进行规范。本研究拟分析以PI-RADS v2为诊断标准时前列腺癌的漏诊及误诊情况。资料与方法以逐层切片病理为"金标准",回顾性分析52例前列腺癌患者的mp-MRI资料,归纳阅片者使用PI-RADS v2读片时存在的问题,分析漏诊及误诊情况。结果逐层切片病理共识别114个癌灶,包括83个临床显著癌。MRI发现91个可疑病灶,真阳性63个,误诊率为30.8%,前列腺癌的漏诊率为38.6%,临床显著癌的漏诊率为24.1%。结论以PI-RADS v2为诊断标准时,前列腺癌会存在较高的误诊率和漏诊率。

Purpose In order to improve the detection rate and diagnostic accuracy of clinically significant prostate cancer（PCa）, prostate imaging reporting and data system version 2（PI-RADS v2） was introduced to standardize multi-parametric MRI（mp-MRI） assessment classification standard. This study was designed to analyze the missed diagnosis and misdiagnosis of PCa when PI-RADS v2 was used as a diagnosis standard. Materials and Methods With step-section pathology as a ＂Golden Standard＂, mp-MRI data of 52 patients with PCa were retrospectively analyzed, the problems confronted by radiologists when reading films with PI-RADS v2 were summarized, and the emphasis was given on missed diagnosis and misdiagnosis. Results 114 PCa foci were identified through stepsection pathology, including 83 clinically significant PCa. MRI found 91 suspicious lesions, in which 63 were true positive, with the misdiagnosis rate of 30.8%. The rate of missed diagnosis of PCa was 38.6%, and the rate of missed diagnosis of clinically significant PCa was 24.1%. Conclusion There will be relatively high rate of misdiagnosis and missed diagnosis when PI-RADS v2 is used as a diagnostic standard.