前列腺多参数磁共振PI-RADS评分预测前列腺癌病理特征:一项影像-全器官病理匹配研究

PI-RADS score of prostate multi-parametric magnetic resonance imaging predicts pathological features of prostate cancer: An imaging to whole-mount pathology matching study

目的:基于匹配影像和全器官病理图像来探讨前列腺多参数磁共振(mpMRI)的PI-RADS评分能否预测前列腺癌病理特征。方法:研究回顾性纳入了单中心2016年8月至2018年12月318例前列腺癌患者,具有术前mpMRI图像、行前列腺根治手术并具有完整的全器官病理切片。对癌灶对应的mpMRI病灶进行PI-RADS评分,并评估病灶的Gleason评分,pT分期,pN分期以及是否具有筛状结构。组间比较采用χ^(2)检验或者Fisher精确检验。受试者工作特征曲线分析用于确定PI-RADS评分在区分不同病理学特征方面的有效性,并得出对应的曲线下面积(AUC)与95%置信区间(CI)。结果:318例患者的中位年龄为69岁,中位术前PSA水平为11.0μg/L,中位肿瘤直径为1.8 cm。PI-RADS评分和前列腺癌病理学Gleason评分、pT分期,pN分期以及筛状结构均显著相关(P<0.01)。PI-RADS评分对于区分Gleason评分(3+3 vs>3+3)的AUC为0.773(95%CI 0.704~0.843),对于区分pT分期(T2 vs>T2)的AUC为0.748(95%CI 0.694~0.803),对于区分pN分期(N0 vs N1)的AUC为0.700(95%CI 0.598~0.802),对于区分筛状结构(阴性vs阳性)的AUC为0.831(95%CI 0.786~0.876)。结论:前列腺癌患者术前mpMRI的PI-RADS评分和术后病理特征(Gleason评分,pT分期,pN分期以及筛状结构)均显著相关,因此术前PI-RADS评分可以用于前列腺癌患者的危险分层。

Objective: To explore the value of the prostate imaging reporting and data system(PI-RADS) score of prostate multi-parametric magnetic resonance imaging(mpMRI) in predicting the pathological features of PCa based on matching images and whole-mount pathology images. Methods: This retrospective study included 318 cases of PCa treated by radical prostatectomy in our hospital from August 2016 to December 2018, with preoperative mpMRI images and complete whole-mount pathological sections. We obtained PI-RADS scores on the mpMRI lesions corresponding to the cancer lesions, evaluated the Gleason scores, pT stages, pN stages and cribriform structure, and compared them between different groups using Chi-square test or Fisher’s exact test. We evaluated the efficiency of the PI-RADS score in distinguishing different pathological features by ROC curve analysis, and obtained the corresponding area under the curve(AUC) and 95% confidence interval(CI). Results: The 318 patients averaged 69 years of age, with a median preoperative PSA level of 11.0 μg/L and a median tumor diameter of 1.8 cm. The PI-RADS score was significantly correlated with the Gleason score, pT stage, pN stage and cribriform structure(all P < 0.01), with AUCs of 0.773(95% CI: 0.704-0.843) for distinguishing Gleason scores(3+3 vs >3+3), 0.748(95% CI: 0.694-0.803) for distinguishing pT stages(T2 vs >T2), 0.700(95% CI: 0.598-0.802) for distinguishing pN stages(N0 vs N1), and 0.831(95% CI: 0.786-0.876) for distinguishing the cribriform structure(negative vs positive). Conclusion: The preoperative PI-RADS score of mpMRI in PCa patients is significantly correlated with postoperative pathological features, and therefore can be used for risk stratification of the malignancy.