PI-RADS v2.1和PI-RADS v2对移行带前列腺癌诊断价值的研究

Study of PI-RADS v2.1 and PI-RADS v2 for diagnostic value of transition zone prostate cancer

目的研究PI-RADS v2.1和PI-RADS v2(第2.1版和第2版前列腺影像报告与数据系统)在移行带前列腺癌(prostate cancer,PCa)和临床显著性前列腺癌(clinically significant prostate cancer,csPCa)诊断中的价值。材料与方法回顾性分析108例[病理证实:PCa 53例、前列腺增生和(或)前列腺炎55例]病变位于移行带的患者的临床与影像资料。两名医师根据PI-RADS v2.1和PI-RADS v2对病灶评分。使用Kappa检验评估2名医师评分结果间的一致性;使用ROC曲线评估PI-RADS v2.1和PI-RADS v2对PCa、csPCa的诊断效能;采用Spearman相关分析对评分结果与Gleason评分的相关性进行分析。结果PI-RADS v2.1的一致性较PI-RADS v2有所提高(Kappa系数全部病变为0.794、0.724,csPCa病变为0.826、0.758,PCa病变为0.734、0.678);PI-RADS v2.1诊断PCa、csPCa的敏感度、准确度和AUC值及PCa的特异度均稍高于PI-RADS v2,P均>0.05;PI-RADS v2.1和PI-RADS v2评分结果均与Gleason评分呈中度正相关(r值分别为0.552和0.507,P均<0.05)。结论PI-RADS v2.1一致性更好,诊断效能不低于PI-RADS v2;PI-RADS评分可以指导穿刺,有助于评估肿瘤的侵袭性。

Objective:To study the diagnostic value of PI-RADS v2.1 and PI-RADS v2(prostate imaging reporting and data system version 2.1 and version 2)in diagnosing transition zone prostate cancer(PCa)and clinically significant prostate cancer(csPCa).Materials and Methods:The clinical and imaging data of 108 patients with transitional zone lesions(53 cases of PCa,55 cases of benign prostatic hyperplasia and/or inflammation)confirmed by pathology were analyzed retrospectively.Two radiologists independently scored the lesions according to PI-RADS v2.1 and PI-RADS v2.Kappa test was used to assess the consistency of the scoring results between two radiologists;ROC curve was used to evaluate and calculate the diagnostic efficiency of PI-RADS v2.1 and PI-RADS v2 for PCa and csPCa.Spearman correlation analysis was used to analyze the correlation between the scoring results and Gleason score.Results:The consistency of PI-RADS v2.1 was improved compared with PI-RADS v2(Kappa value was 0.794 vs.0.724 for all lesions,0.826 vs.0.758 for csPCa lesions,0.734 vs.0.678 for PCa lesions);the sensitivity,accuracy and AUC value of PI-RADS v2.1 in diagnosing PCa and csPCa and specificity of PI-RADS v2.1 in diagnosing PCa were slightly higher than those of PI-RADS v2(AUC:0.949 vs.0.922 for PCa,0.955 vs.0.931 for csPCa;sensitivity:0.981 vs.0.943 for PCa,0.978 vs.0.956 for csPCa;specificity:0.764 vs.0.745 for PCa),but the difference was not significant(all P>0.05);the scoring results of PI-RADS v2.1 and PI-RADS v2 were moderately positively correlated with Gleason score(r=0.552 vs.r=0.507,P<0.05).Conclusions:PI-RADS v2.1 has better consistency and the diagnostic efficiency is not lower than PI-RADS v2 for transition zone PCa and csPCa;the PI-RADS score can guide the puncture and help assess the aggressiveness of the tumor.