PI-RADS v2评分结合前列腺特异性抗原密度对早期有临床意义前列腺癌的诊断价值  

Diagnostic value of PI-RADS v2 score combined with prostate specific antigen density in early stage of clinically significant prostate cancer

作　　者：周理乾[1] 樊国峰[1] 马少君[1] 刘辉[1] 刘彤 任伟[1] ZHOU Liqian;FAN Guofeng;MA Shaojun;LIU Hui;LIU Tong;REN Wei(Radiology Department,Shaanxi Provincial People's Hospital,Xi'an 710068,China)

机构地区：[1]陕西省人民医院放射科,陕西西安710068

出　　处：《临床医学研究与实践》2021年第18期25-28,共4页Clinical Research and Practice

基　　金：陕西省科技厅2020年社会发展领域项目(No.2020SF-056);陕西省科技厅2018年社会发展领域项目(No.S2018-YF-YBSF-0772)。

摘　　要：目的探讨基于3.0T多参数磁共振成像(mpMRI)的第2版前列腺影像报告与数据系统(PI-RADS v2)结合前列腺特异性抗原密度(PSAD)对早期有临床意义前列腺癌(CSPCa)的诊断价值。方法回顾性分析203例前列腺特异性抗原(TPSA)增高患者的临床资料,病灶均限于前列腺包膜内。对前列腺mpMRI图像行PI-RADS v2评分,结合相应临床检验指标,以穿刺病理结果为金标准,通过Logistic回归建立联合预测模型Logit(P),应用ROC曲线分析其诊断效能。采用Delong检验比较独立预测指标和Logit(P)在低危组(TPSA为4~<10 ng/mL)、中危组(TPSA为10~<20 ng/mL)及高危组(TPSA为≥20 ng/mL)中ROC曲线下面积(AUC)。结果203例患者中,非CSPCa患者141例,CSPCa患者62例。Logistic回归显示,PI-RADS v2评分和PSAD为CSPCa的独立预测指标;Logit(P)=-6.171+1.24×PI-RADS v2评分+1.99×PSAD。Logit(P)的AUC(95%CI)为0.84(0.78~0.89),高于PI-RADS v2评分的0.78(0.73~0.85)、PSAD的0.75(0.69~0.81)(P<0.05)。Logit(P)在高危组的AUC(95%CI)为0.93(0.83~0.98),高于中危组的0.79(0.69~0.86)和低危组的0.82(0.71~0.89),差异具有统计学意义(P<0.05)。通过PSAD分层后发现,当PI-RADS v2评分≤3分以及PSAD<0.3 ng/mL2时,其灵敏度和NPV均为100%,约有17.24%患者可避免不必要穿刺。结论PI-RADS v2评分联合PSAD可提高对早期CSPCa的诊断效能,在TPSA高危组中效能最佳,并可能在一定程度上减少不必要的前列腺穿刺。Objective To explore the diagnostic value of prostate imaging reporting and data system version 2(PI-RADS v2)based on 3.0 T multi-parametric magnetic resonance imaging(mpMRI)combined with prostate specific antigen density(PSAD)in early stage of clinically significant prostate cancer(CSPCa).Methods The clinical data of 203 patients with increased total prostate specific antigen(TPSA)were retrospectively analyzed,all lesions were confined to the prostatic capsule.PI-RADS v2 score was performed on the mpMRI images of prostate.Combined with the corresponding clinical test indexes,the puncture pathology result as the gold standard,the combined prediction model Logit(P)was established by Logistic regression,and the diagnostic efficacy was analyzed by ROC curve.Delong test was used to compare the area under the ROC curve(AUC)of independent predictor and Logit(P)in low-risk group(TPSA 4-<10 ng/mL),medium-risk group(TPSA 10-<20 ng/mL)and high-risk group(TPSA≥20 ng/mL).Results In the 203 patients,141 cases were non-CSPCa patients and 62 cases were CSPCa patients.Logistic regression showed that PI-RADS v2 score and PSAD were independent predictors of CSPCa.Logit(P)=-6.171+1.24×PI-RADS v2 score+1.99×PSAD.AUC(95%CI)of Logit(P)was 0.84(0.78-0.89),which was higher than 0.78(0.73-0.85)of PI-RADS v2 score and 0.75(0.69-0.81)of PSAD(P<0.05).The AUC(95%CI)of Logit(P)in the high-risk group was 0.93(0.83-0.98),which was higher than 0.79(0.69-0.86)in the medium-risk group and 0.82(0.71-0.89)in the low-risk group,and the differences were statistically significant(P<0.05).After layered by PSAD,when the PI-RADS v2 score was≤3 and PSAD was≤0.3 ng/mL2,the sensitivity and NPV were 100%.About 17.24%of patients might avoid unnecessary puncture.Conclusion PI-RADS v2 score combined with PSAD can improve the diagnostic efficiency of early stage of CSPCa,which is the best in TPSA high-risk group,and may reduce unnecessary prostate puncture to a certain extent.

关 键 词：第2版前列腺影像报告与数据系统 前列腺特异性抗原密度 有临床意义前列腺癌 多参数磁共振成像 

分 类 号：R737.25[医药卫生—肿瘤]