第2版和第2.1版前列腺影像报告与数据系统对临床显著性前列腺癌诊断效能的比较分析

Comparison of the diagnostic value of prostate imaging reporting and data system version 2 and version 2.1 in the detection of clinically significant prostate cancer

目的:比较第2版和第2.1版前列腺影像报告与数据系统(PI-RADS V2、V2.1)对临床显著性前列腺癌(csPCa)的诊断效能。方法:回顾性分析2015年5月至2019年8月苏州大学附属第二医院行前列腺多参数MRI检查的837例患者的影像、病理及临床资料。根据前列腺穿刺病理结果,格林森评分(GS)≥3+4的前列腺癌为csPCa。以简单随机抽样法抽取其中25%(209例)患者,由两名影像科医师对主病灶分别行PI-RADS V2、V2.1诊断评分,采用加权Kappa检验评估两名医师评分结果间的一致性。剩余病例由其中1名医师运用两种评分方式分别评分。采用ROC曲线在总病灶、外周带病灶、移行带病灶中评估两种评分方式对csPCa的诊断效能,通过Z检验比较曲线下面积(AUC)的差异。结果:csPCa患者251例,其中外周带163例,移行带88例。两名医师运用PI-RADS V2和V2.1对随机抽取的总病变、移形带病变、外周带病变的评分结果间的加权Kappa值分别为0.757、0.653、0.748和0.794、0.707、0.759。PI-RADS V2.1在总病变、移行带病变、外周带病变中诊断csPCa的AUC分别为0.922、0.932、0.854,PI-RADS V2分别为0.902、0.905、0.817,差异均有统计学意义(Z=4.104,P<0.001;Z=2.538,P=0.011;Z=3.350,P<0.001)。结论:PI-RADS V2.1较V2对前列腺病变评分一致性加权Kappa值稍高,且对csPCa的诊断效能高于PI-RADS V2。

Objective To compare the diagnostic value between prostate imaging reporting and data system version 2(PI-RADS V2)and version 2.1(PI-RADS V2.1)for clinically significant prostate cancer(csPCa).Methods The imaging,pathological and clinical data of 837 patients with prostatic multiparametric MRI in Second Affiliated Hospital of Soochow University from May 2015 to August 2019 were retrospectively analyzed.According to the pathological results of systematic biopsy,the prostate cancer with Gleason score(GS)≥3+4 was csPCa.A total of 25%of the patients(209 cases)were selected using a simple random sampling,and the index lesions were scored by 2 radiologists with PI-RADS V2 and V2.1,respectively.The weighted Kappa test was used to evaluate the consistency of the scores interpreted between the 2 radiologists.The remaining cases were scored by one of the radiologists using the 2 scoring system respectively.The ROC curve was used to evaluate the diagnostic performance of the 2 scoring system for csPCa in total lesions,peripheral lesions and transitional lesions.Z test was used to investigate whether there was any difference in the detection efficiency between the 2 scoring system.Results There were 251 patients with csPCa,including 163 patients in peripheral zone and 88 patients in transitional zone.The weighted Kappa value of total lesions,transitional lesions,peripheral lesions was 0.757,0.653,0.748 for PI-RADS V2 and 0.794,0.707,0.759 for PI-RADS V2.1,respectively.In total lesions,transitional lesions and peripheral lesions,the area under the ROC curve of csPCa detected by PI-RADS V2.1 was 0.922,0.932,0.854 and 0.902,0.905,0.817 by PI-RADS V2,respectively,and all the differences were statistically significant(Z=4.104,P<0.001;Z=2.538,P=0.011;Z=3.350,P<0.001).Conclusion PI-RADS V2.1 has a slightly higher consistent weighted Kappa value in evaluating prostate lesions than PI-RADS V2,and the detection efficiency of csPCa was higher than PI-RADS V2.