前列腺特异性抗原及其衍生指标在第二版前列腺影像报告与数据系统3分病灶临床决策中的价值

The clinical decision-making value of prostate specific antigen and its derived indicators in prostate imaging reporting and data system version 23 lesions

目的探讨临床相关指标在第2版前列腺影像报告与数据系统(PI-RADS V2)3分病灶临床穿刺活检决策中的价值,比较上述观察指标对前列腺癌(PCa)和临床显著性前列腺癌(csPCa)的诊断效能。方法回顾性分析2016年3月至2018年10月苏州大学附属第二医院121例前列腺主病灶PI-RADS V2评分为3分患者的病例资料,PCa 31例,csPCa 14例,患者年龄46~91(71±9)岁。比较年龄、前列腺特异性抗原(PSA)、游离前列腺特异性抗原(fPSA)、前列腺特异性抗原游离与总量比值(f/tPSA)、前列腺特异性抗原密度(PSAD)以及前列腺体积(PV)在PCa组和非PCa组间以及csPCa组和非csPCa组间的差异,运用受试者工作特性(ROC)曲线比较差异有统计学意义的指标对PI-RADS 3分患者的PCa及csPCa的诊断价值。结果患者的PSA、f/tPSA、PSAD值在PCa组和非PCa组间(Z=-2.004、-2.527、-2.623,均P<0.05)以及csPCa组和非csPCa组间(Z=-2.415、-2.158、-2.870,均P<0.05)差异均有统计学意义,且均以PSAD诊断效能最高,其检出PCa和csPCa的ROC曲线下面积分别为0.658和0.736。若以PSAD>0.20μg·L^-1·ml^-1作为穿刺参考阈值,诊断csPCa的敏感度、特异度、阳性预测值、阴性预测值分别为78.6%、58.9%、20.0%、95.4%,有54.5%(66/121)的病例可避免穿刺,3例csPCa漏诊。结论PSA、f/tPSA、PSAD,尤其是PSAD可提高PI-RADS 3分病灶中PCa,尤其是csPCa的检出效能,对临床决策制定具有重要参考价值。

Objective To explore the decision-making value of clinical data in prostate imaging reporting and data system version 2(PI-RADS V2)3 lesions,and to compare the diagnostic value of related data for prostate cancer(PCa)and clinically PCa(csPCa).Methods From March 2016 to October 2018,a subset of 121 men with 121 PI-RADS 3 index lesions were retrospectively analyzed.There were 31 PCa lesions and 14 csPCa lesions,aged from 46 to 91 years with a mean age of(71±9)years.The clinical data of the age,prostate specific antigen(PSA),free PSA(fPSA),f/tPSA,PSA density(PSAD)and prostate volume(PV)were compared between PCa group and non-PCa group,csPCa group and non-csPCa group using univariate analysis,respectively.The receiver operating characteristic(ROC)curve was used to evaluate the efficiency of statistically data in detecting PCa and csPCa in men with PI-RADS 3 index lesions.Results The differences of PSA,f/tPSA and PSAD were all statistically significant(Z=-2.004,-2.527,-2.623,all P<0.05)between PCa group and non-PCa group,and they were all also statistically significant(Z=-2.415,-2.158,-2.870,all P<0.05)between csPCa group and non-csPCa group.Both PSAD had the best diagnostic efficiency,the ROC curve of detecting PCa and csPCa was 0.658 and 0.736,respectively.If used PSAD>0.20μg·L^-1·ml^-1 as the biopsy threshold,the sensitivity,specificity,positive predictive value and negative predictive value of csPCa were 78.6%,58.9%,20.0%,95.4%,and 54.5%(66/121)of the enrolled men can avoid biopsy,resulting only 3 cases of csPCa missed.Conclusion PSA,f/tPSA,PSAD,especially PSAD can improve the detection efficiency of PCa,especially csPCa in PI-RADS 3 lesions,assisting clinical decision-making.