PI-RADS V2评分系统中低评分患者临床特征分析

Analysis of the clinical characteristics of patients with low and medium PI-RADS V2score

目的:分析前列腺多参数核磁共振检查第2版前列腺影像报告与数据系统(prostate imaging-reporting and data system version 2,PI-RADS V2)中低评分患者的临床特征。方法:回顾性分析2015年7月—2019年7月在上海交通大学附属仁济医院行经会阴前列腺穿刺活检,并且术前行多参数核磁共振检查的2588例患者的临床资料,患者年龄25~91岁,平均(67.6±7.9)岁;PSA中位数11.49(7.49,20.74)ng/mL,其中983例PSA位于灰区(4~10ng/mL)。2588例患者中,PI-RADS V2评分2分302例(11.7%),3分238例(9.2%),4分1842例(71.2%),5分206例(7.9%)。采用logistic单因素和卡方检验对中低PI-RADS V2评分(≤3分)患者的临床特征进行分析。结果:2588例经会阴前列腺穿刺活检者中有1259(48.6%)例患者穿刺病理为前列腺癌(prostate cancer,PCa),以PI-RADS V2评分>3分为界,PI-RADS V2中低评分者占6.6%(83/1259),临床分期均≤cT2cN0M0期,其中48.2%(40/83)为临床无显著意义前列腺癌(clinically insignificant prostate cancer,ciPCa)。以PI-RADS V2评分>3分为穿刺指征,可使17.7%(457/2588)的患者避免不必要的穿刺,而且漏诊83例中所有患者均为局限性PCa,其中ciPCa占48.2%;在PSA值位于灰区的983例患者中,穿刺阳性率为33.9%(333/983),以PI-RADS V2评分>3分为穿刺指征,可使20.3%(200/983)的患者避免不必要的穿刺,而且漏诊26例中所有患者均为局限性PCa,其中ciPCa患者占69.2%(18/26)。结论:多参数核磁共振检查对评估患者是否需要进行前列腺穿刺具有指导意义,在PI-RADS V2≤3分的患者中,仍有部分患者穿刺病理为PCa,但是相对于PI-RADS高评分者其临床分期及Gleason评分明显偏低,其中ciPCa占大部分;而对于PSA值位于灰区的患者,采用PIRADS V2对患者进行评估可大幅减少不必要的前列腺穿刺。

Objective:To analyze the clinical characteristics of patients with low and medium prostate imaging reporting and data system version 2(PI-RADS V2)score.Methods:A retrospective analysis was performed on the clinical data of 2588patients who underwent transperineal prostate needle biopsy and preoperative multi-parameter MRI in Renji Hospital affiliated to Shanghai Jiao Tong University from July 2015to July 2019.The patients'age ranged from 25to 91years old,with an average age of(67.6±7.9)years.Median PSA was 11.49(7.49,20.74)ng/mL,of which 983cases were located in the PSA grey area(4-10ng/mL).PI-RADS scored 2 in 302patients(11.7%),3in 238patients(9.2%),4in 1842patients(71.2%),and 5in 206patients(7.9%).Logistic univariate test and Chi-square test were used to analyze the clinical characteristics of patients with low and medium PI-RADS V2score(≤3points).Results:Among the 2588patients undergoing transperineal prostate biopsy,there were 1259(48.6%)patients whose biopsy pathology was PCa.When divided by PI-RADS V2score of 3low and medium PI-RADS V2score accounted for 6.6%(83/1259),the clinical stage was all≤cT2cN0M0,and 48.2%(40/83)of them were ciPCa.When PI-RADS V2score>3was considered to be one of prostate biopsy indications,unnecessary prostate biopsy could be avoided in 17.7%(457/2588)of the patients,and all of the 83 patients missed diagnosis were localized PCa,of which 48.2%was ciPCa.Among the 983patients with PSA val-ue in the grey area,the positive rate of prostate biopsy was 33.9%(333/983).Setting PI-RADS V2score>3as one of prostate biopsy indications could avoid unnecessary prostate biopsy in 20.3%(200/983)of the patients.In addition,all the 26patients with missed diagnosis were localized PCa,of which 69.2%(18/26)was ciPCa.Conclusion:Using multi-parameter MRI to evaluate whether patients with the need for prostate biopsy has a guiding significance.In patients with PI-RADS V2score≤3there are still a part of the prostate biopsy in patients with PCa.However,compared with those with high PI-RADS V2score,the clinical staging and Gleason score were significantly lower,most of them were ciPCa.For patients with PSA in the grey area,the use of PI-RADS V2to evaluate patients can significantly reduce unnecessary prostate biopsy.