北京大学学报（医学版）2024，Vol.56Issue(4)：567-574,8.DOI:10.19723/j.issn.1671-167X.2024.04.004
双参数MRI改良PI-RADS评分4分和5分病灶的最大径对临床有意义前列腺癌的预测效果
Predictive effect of the dual-parametric MRI modified maximum diameter of the lesions with PI-RADS 4 and 5 on the clinically significant prostate cancer
摘要
Abstract
Objective:To assess the rationality of the maximum lesion diameter of 15 mm in prostate imaging reporting and data system(PI-RADS)as a criterion for upgrading a lesion from category 4 to 5 and improve it to enhance the prediction of clinically significant prostate cancer(csPCa).Methods:In this study,the patients who underwent prostate magnetic resonance imaging(MRI)and prostate biopsy at Peking University First Hospital from 2019 to 2022 as a development cohort,and the patients in 2023 as a validation cohort were reviewed.The localization and maximum diameter of the lesion were fully evalua-ted.The area under the curve(AUC)and the cut-off value of the maximum diameter of the lesion to pre-dict the detection of csPCa were calculated from the receiver operating characteristics(ROC)curve.Confounding factors were reduced by propensity score matching(PSM).Diagnostic efficacy was com-pared in the validation cohort.Results:Of the 589 patients in the development cohort,358(60.8％)lesions were located in the peripheral zone and 231(39.2％)were located in the transition zone,and 496(84.2％)patients detected csPCa.The median diameter of the lesions in the peripheral zone was smaller than that in the transition zone(14 mm vs.19 mm,P＜0.001).In the ROC analysis of the maximal diameter on the csPCa prediction,there was no statistically significant difference between the peri-pheral zone(AUC=0.709)and the transition zone(AUC=0.673,P=0.585),and the cut-off values were calculated to be 11.5 mm for the peripheral zone and 16.5 mm for the migrating zone.By calcula-ting the Youden index for the cut-off values in the validation cohort,we found that the categorisation by lesion location led to better predictive results.Finally,the net reclassification index(NRI)was 0.170.Conclusion:15 mm as a criterion for upgrading the PI-RADS score from 4 to 5 is reasonable but too general.The cut-off value for peripheral zone lesions is smaller than that in transitional zone.In the future consideration could be given to setting separate cut-off values for lesions in different locations.关键词
前列腺肿瘤/多参数磁共振成像/活组织检查/临床决策规则/前列腺影像报告和数据评分系统Key words
Prostatic neoplasms/Multiparametric magnetic resonance imaging/Biopsy/Clinical deci-sion rules/Prostate imaging reporting and data system分类
医药卫生引用本文复制引用
田宇轩,阮明健,刘毅,李德润,吴静云,沈棋,范宇,金杰..双参数MRI改良PI-RADS评分4分和5分病灶的最大径对临床有意义前列腺癌的预测效果[J].北京大学学报（医学版）,2024,56(4):567-574,8.基金项目
中央高水平医院临床科研业务费(北京大学第一医院院内交叉临床研究专项)(2022CR16)Supported by the National High Level Hospital Clinical Research Funding(Interdepartmental Clinical Research Project of Peking University First Hospital)(2022CR16) （北京大学第一医院院内交叉临床研究专项）
