PI-RADS v2评分联合PSA、PSAD检测在有临床意义前列腺癌中的诊断价值

The diagnostic value of PI-RADS v2 score combined with PSA,PSAD in clinical significant prostate cancer

目的探讨前列腺影像报告和数据系统(PI-RADS v2)评分联合血清前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)在有临床意义前列腺癌诊断(csPCa)中的价值。方法回顾性分析病理证实的112例前列腺患者术前多参数磁共振(mpMRI)及血清PSA资料。用受试者工作特征曲线(ROC)分析患者PI-RADS v2评分、年龄、总PSA(tPSA)、游离PSA(fPSA)、f/tPSA比值、PSAD对csPCa的诊断效能。用获取的最佳界值,分别与PI-RADS v2评分联合,分析诊断csPCa的敏感性、特异性、诊断准确性、阳性预测值、阴性预测值。结果112例患者(52例csPCa和60例前列腺良性病变)平均年龄69.15岁。2位观察者PI-RADS v2评分一致性较好(Kappa值=0.76)。ROC曲线显示PI-RADS v2评分、PSAD、tPSA对csPCa有较好的诊断效能,本组fPSA及患者年龄对csPCa诊断效能不高,两组间差异没有显著统计学意义(P>0.05);f/tPSA比值呈反相曲线(AUC=0.268)。PI-RADS v2评分联合PSAD(并联)诊断csPCa的效能最高。结论前列腺多参数磁共振PI-RADS v2评分、tPSA、PSAD对csPCa有较好诊断效能,PI-RADS v2评分联合PSAD(并联)诊断效能更好。

Objective To explore the diagnostic value of combined application of prostate imaging report and data system v2(PI-RADS v2),serum prostate specific antigen(PSA)and prostate specific antigen density(PSAD)in clinical significant prostate cancer(csPCa).Methods The MRI and PSA data of 112 patients with prostate lesions were retrospectively analyzed.The diagnostic efficacy of PI-RADS v2 score,age,total PSA(tPSA),free PSA(fPSA),f/tTPSA ratio and PSAD were shown by receiver operating characteristic(ROC)curve.The optimal threshold values of the above better diagnostic efficiency factors were determined using the Yoden Index.The sensitivity,specificity,diagnostic accuracy,positive predictive value and negative predictive value of the diagnostic csPCa were analyzed by combined application PI-RADS v2 score and PSA or PSAD.Results The average age of 112 patients(52 patients with csPCa and 60 patients with benign prostate lesions)was 69.15 years.The PI-RADS v2 scores of two radiologists were good consistent(Kappa value=0.76).The ROC curve showed that the diagnostic values of PI-RADS v2 score,PSAD and tPSA were higher.The fPSA and the age of patients in two groups had no significant difference(P>0.05).The f/tPSA ratio presented an inverse curve(AUC=0.268).The diagnostic efficiency of PI-RADS combined with PSAD(parallel connection)were highest.Conclusion PI-RADS v2 score,tPSA,PSAD are efficient.PI-RADS v2 score combined with PSAD(parallel connection)can further improve the diagnostic level in the diagnosis of csPCa.