第2版前列腺影像报告及数据系统评分在前列腺癌诊断中的价值  

The value of the prostate imaging reporting and data system version 2 for the diagnosis of prostate cancer

作　　者：方志伟[1] 许克新[1] 胡浩[1] 梁晨[1] 王焕瑞 张维宇[1] 

机构地区：[1]北京大学人民医院泌尿外科,100044

出　　处：《中华泌尿外科杂志》2018年第1期19-23,共5页Chinese Journal of Urology

摘　　要：目的探讨第2版前列腺影像报告及数据系统（prostate imaging reporting and data system，PI-RADS）评分对前列腺癌的诊断价值。 方法回顾性分析我院2015年8月至2017年2月收治的243例行前列腺穿刺活检术或根治性前列腺切除术，且术前行前列腺核磁检查患者的临床资料。年龄（68.8±7.9）岁，范围43～86岁。tPSA 9.83 ng/ml （1.54～477.27 ng/ml），fPSA 1.18 ng/ml （0.06～30.92 ng/ml）。111例位于PSA灰区（4.0～10.0 ng/ml）。前列腺单发结节203例，多发结节40例。243例共285个结节，其中恶性结节131个，Gleason评分6分30个、7分61个、8分21个、9分17个、10分2个分析第2版PI-RADS评分各分之间前列腺癌阳性预测值的差异；评估第2版PI-RADS评分诊断前列腺癌的敏感性与特异性；应用受试者工作特征曲线（ROC）评估第2版PI-RADS评分诊断前列腺癌的准确性，比较其对外周带和移行带前列腺癌的预测价值。评价第2版PI-RADS评分对PSA灰区患者的诊断价值。 结果243例患者中285个结节纳入最终分析，其中恶性结节131例。第2版PI-RADS评分1～5分的阳性预测值分别为8.0%、10.1%、49.2%、61.1%、87.9%，差异有统计学意义（P〈0.01）；有显著临床意义前列腺癌的阳性预测值分别为0、5.1%、31.1%、59.3%、88.9%，差异有统计学意义（P〈0.01）。第2版PI-RADS评分诊断前列腺癌准确性的ROC曲线下面积为0.85（95%CI 0.80～0.89）。第2版PI-RADS评分为3分时的约登指数最大（0.53），诊断前列腺癌的敏感性和特异性分别为92.4%和61.0%。移行带结节与外周带结节的ROC曲线下面积分别为0.86（95%CI 0.78～0.95）和0.83（95%CI 0.77～0.89）。111例PSA灰区患者中33例诊断为前列腺癌，以第2版PI-RADS评分3分为穿刺指征，可使42.3%（47/111）的患者避免不必要的穿刺，漏诊4例无显著临床意义前列腺癌患者。 结论第2版PI-RADS评分与前列腺癌阳性预测值呈正相�ObjectiveTo evaluate the value of the prostate imaging reporting and data system version 2 （PI-RADS version 2） for the diagnosis of prostate cancer. MethodsA total of 243 patients who underwent multiparametric 3T prostate MRI followed by prostate biopsy or radical prostatectomy were included. 111 patients were in PSA gray zone（4.0-10.0 ng/ml）. PI-RADS version 2 scores for each patient was assigned by two readers independently. Reference standard was obtained by histopathology. Positive predictive value （PPV） for prostate cancer and clinically significant cancer were compared among patients with different PI-RADS Version 2 scores using chi-square trend test. Receiver operating characteristic （ROC） curve was performed to assess diagnostic accuracy of the PI-RADS version 2 scores for prostate cancer detection, and evaluate the difference in diagnostic efficiency between transition zone and peripheral zone. ResultsTwo hundred and eighty five suspicious foci from the 243 patients were finally recruited to this study, 131 of which were diagnosed as prostate cancer according to pathology. There was significant difference in PPV for prostate cancer and clinically significant cancer among patients with different PI-RADS version 2 scores （score 1： 8.0%; score 2： 10.1%; score 3： 49.2%; score 4： 61.1% score 5： 87.9%, P〈0.01）, （score 1： 0; score 2： 5.1%; score 3： 31.1%; score 4： 59.3% score 5： 88.9%, P〈0.01）. When PI-RADS version 2 score was 3, Youden index was maximum （0.53）, the sensitivity was 92.4% and the specificity was 61.0%. The ROC analysis revealed that the area under the curve （AUC） of prostate cancer incidence in transition zone was similar to that in peripheral zone with 0.86（95%CI 0.78-0.95） vs. 0.83（95%CI 0.77-0.89）. There were 111 patients in PSA gray zone, 33 of whom were diagnosed as prostate cancer. If we used PI-RADS version 2 score 3 as the cut-off point, 47 out of 111 patients would avoid unnecessary prostate biopsies with 4 misdiagnosed

关 键 词：核磁共振成像 第2版前列腺影像报告及数据系统评分 前列腺癌 诊断 

分 类 号：R737.25[医药卫生—肿瘤]