PI-RADSv2.1联合PSAD分层预测PSA4~20 ng/mL外周带临床显著性前列腺癌患者的价值

The Value of PI-RADS v2.1 Combined with PSAD Stratification in PredictingPeripheral Zone Clinically Significant Prostate Cancer in Patients with PSA 4-20 ng/mL

目的:研究第2.1版前列腺影像报告和数据系统(PI-RADSv2.1)联合前列腺特异性抗原(PSA)密度(PSAD)分层预测PSA4~20ng/mL外周带临床显著性前列腺癌(csPCa)患者的价值,以避免不必要的穿刺活检。方法:回顾性分析经病理证实的200例病变位于外周带前列腺癌患者(非csPCa组170例,csPCa组30例)的资料。2名医师使用PI-RADSv2.1独立评分,并使用Kappa检验评估评分结果的一致性。分析不同PI-RADSv2.1评分联合PSAD分层预测csPCa的检出率。使用受试者工作特征(ROC)曲线评估PI-RADS v2.1联合PSAD诊断csPCa的诊断效能。结果:2名医师评分结果一致性的Kappa值为0.716。PI-RADSv2.1评分为1~2分、3分、4~5分时,csPCa的检出率分别为0.0%、9.5%、43.8%;不论PSAD分层如何(<0.09ng/mL^(2)、0.09~0.15ng/mL^(2)、0.15~0.19ng/mL^(2)、0.19~0.30 ng/mL^(2)、≥0.30 ng/mL),PI-RADSv2.11~2分病变均未检出csPCa;PSAD<0.30ng/mL^(2)时,3分病变均未检出csPCa,PSAD≥0.30ng/mL时,3分病变csPCa的检出率为28.6%;PSAD<0.09ng/mL时,4~5分病变未检出csPCa,PSAD≥0.09ng/mL时,4~5分病变的检出率均较高(37.5%、37.5%、38.5%、51.5%)。PI-RADSv2.1联合PSAD诊断csPCa的曲线下面积(AUC)高于PIRADSv2.1(0.923比0.906;Z=2.14,P=0.032)或PSAD(0.923比0.742;Z=3.00,P=0.003)。结论:PIRADSv2.1评分一致性较好;不论PSAD分层如何,评分为1~2分的患者可以避免不必要的穿刺活检,3~5分的患者结合PSAD分层,部分患者可以避免不必要的穿刺活检;PI-RADSv2.1联合PSAD诊断csPCa的诊断效能优于PI-RADSv2.1或PSAD。

Purpose:To study the value of prostate imaging report and data system version 2.1(PI-RADS v2.1)combined with prostate specific antigen density(PSAD)stratification for predicting clinically significant prostate cancer(csPCa)in peripheral zone(PZ)in patients with PSA 4-20 ng/mL,in order to avoid unnecessary puncture biopsy.Methods:The data from 200 patients(170 in the non-csPCa group and 30 in the csPCa group)with pathologically confirmed lesions located in the PZ were analyzed retrospectively.Two radiologists independently scored the lesions using PI-RADS v2.1 and assessed the consistency of the scoring results using the Kappa test.Besides,different PI-RADS v2.1 scores combined with PSAD stratification were analyzed to predict the detection rate of csPCa.Next,receiver operating characteristic(ROC)curve was used to evaluate the diagnostic performance of PI-RADS v2.1 combined with PSAD in diagnosing csPCa.Results:The Kappa value for the consistency of the scoring results between the two radiologists was 0.716.The detection rates of csPCa were 0.0%,9.5%and 43.8%for PI-RADS v2.1 scores of 1 to 2,3,and 4 to 5,respectively.Regardless of PSAD stratification(<0.09 ng/mL^(2),0.09 to 0.15 ng/mL,0.15 to 0.19 ng/mL^(2),0.19 to 0.30 ng/mL^(2),≥0.30 ng/mL^(2)),no csPCa was detected in PI-RADS v2.1 score 1-2 lesions.Also,when PSAD<0.30 ng/mL^(2),no csPCa was detected in PI-RADS v2.1 score 3 lesions.When PSAD≥0.30 ng/mL^(2),detection rate of PI-RADS v2.1 score 3 lesions was 28.6%,while when PSAD<0.09 ng/mL^(2),no csPCa was detected in PI-RADS v2.1 score 4-5 lesions.Besides,when PSAD≥0.09 ng/mL^(2),detection rate of PIRADS v2.1 score 4-5 lesions were higher(37.5%,37.5%,38.5%,51.5%).Last,the area under the curve(AUC)of PIRADS v2.1 combined with PSAD in diagnosing csPCa was higher than that of PI-RADS v2.1(0.923 vs 0.906;Z=2.14,P=0.032)or PSAD(0.923 vs 0.742;Z=3.00,P=0.003).Conclusion:The consistency of PI-RADS v2.1 score is better;regardless of PSAD stratification,patients with PI-RADS v2.1 scores of Ito 2 could avoid unnecessary puncture biopsies,and patients with PI-RADS v2.1 scores of 3 to 5 combined with PSAD stratification could avoid unnecessary puncture biopsies in some patients.Last,the diagnostic performance of PI-RADS v2.1 combined with PSAD for the diagnosis of csPCa is better than PI-RADS v2.1 or PSAD.