基于前列腺影像报告数据系统及多参数MRI对移行带前列腺癌的诊断价值

Diagnostic Value of Prostate Imaging Reporting and Data System and Multi-parametric MRI for Transitional Zone Prostate Cancer

目的探讨PI-RADS v2.1对移行带前列腺癌(prostate cancer,PCa)及临床显著前列腺癌(clinically significant prostate cancer,csPCa)的诊断价值。方法回顾性分析2019年8月至2022年6月宁夏回族自治区人民医院收治行前列腺活检穿刺术或根治性前列腺切除术,主病变位于移行带的86例(病理确诊:前列腺癌43例,前列腺增生合并前列腺炎43例)患者,患者术前临床资料及影像资料齐全。以病理Gleason评分为金标准,由年资不同的两位医师严格依据PI-RADS v2.1进行盲法评分,运用受试者工作特征(receiver operating characteristic,ROC)曲线分析并计算PI-RADS v2.1评分对移行带PCa和csPCa的诊断价值,采用Spearman相关分析分析PI-RADS v2.1评分结果与病理Gleason评分的相关性。结果PI-RADS v2.1评分检出移行带PCa和csPCa的AUC值分别为0.967(95%CI:0.933~1.000)和0.980(95%CI:0.958~1.000),差异有统计学意义(P<0.01)。PI-RADS v2.1评分为3分和4分时,诊断移行带PCa的敏感度、特异度、准确度和约登指数分别为97.67%、74.42%、88.10%、0.73和88.37%、95.35%、94.05%、0.84;PI-RADS v2.1评分为3分和4分时,诊断移行带csPCa的敏感度、特异度、准确度、约登指数分别为100%、70.21%、85.71%、0.70和94.87%、93.62%、96.43%、0.88。PI-RADS v2.1评分与Gleason评分呈正相关(r=0.851,P<0.01)。结论PI-RADS v2.1对前列腺移行带PCa和csPCa具有较高的诊断价值,医师间诊断一致性较佳,可以避免前列腺患者不必要的穿刺。

Objective To investigate the diagnostic value of PI-RADS v2.1 for transitional zone prostate cancer and clinically significant prostate cancer.Methods To analyze retrospectively of 86 patients with prostate biopsy or radical prostatectomy who were admitted to the People's Hospital of Ningxia Hui Autonomous Region from August 2019 to June 2022,whose main lesions were located in the transitional zone(pathological diagnosis:43 cases of prostate cancer,43 cases of hyperplasia and prostatitis),and the patients had complete clinical and imaging data before surgery.Taking the pathological Gleason score as the gold standard,two physicians with different seniority performed blind scoring strictly according to PI-RADS v2.1,and the receiver operating characteristic(ROC)curve analysis was used to analyze and calculate the diagnostic value of PI-RADS v2.1 of transitional zone PCa and csPCa.Spearman correlation analysis was used to analyze the correlation between PI-RADS v2.1 score and pathological Gleason score.Results The AUC values of PCa and csPCa in the transitional zone detected by PI-RADS v2.1 were 0.967(95%CI:0.933-1.000)and 0.980(95%CI:0.958-1.000),respectively,and the difference was statistically significant(P<0.01).When the PI-RADS v2.1 scores were 3 and 4,the sensitivity,specificity,accuracy,and Youden index for diagnosing transitional zone PCa were 97.67%,74.42%,88.10%,0.73 and 88.37%,95.35%,94.05%,0.84;when the PI-RADS v2.1 scores were 3 and 4,the sensitivity,specificity,accuracy and Youden index for diagnosing transitional zone csPCa were 100%,70.21%,85.71%,0.70 and 94.87%,93.62%,96.43%,0.88.PI-RADS v2.1 score was highly positively correlated with Gleason score(r=0.851,P<0.01).Conclusion PI-RADS v2.1 has high diagnostic value for PCa and csPCa in the transitional zone of the prostate,and the diagnostic consistency among physicians is good.It can avoid unnecessary puncture in prostate patients.