PI-RADS评分诊断不同PSA水平前列腺癌的准确度分析  

Accuracy of PI-RADS score in diagnosing prostate cancer at different PSA levels

作　　者：吴翰昌 刘芳[1] 马超[1] 汪剑[1] WU Hanchang;LIU Fang;MA Chao;WANG Jian(Department of Radiology,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)第一附属医院放射诊断科,上海200433

出　　处：《海军军医大学学报》2025年第2期223-228,共6页Academic Journal of Naval Medical University

基　　金：海军军医大学(第二军医大学)校级课题(2022QN047).

摘　　要：目的探讨在不同前列腺特异性抗原(PSA)水平基础上,前列腺影像报告和数据系统(PI-RADS)评分诊断前列腺癌(PCa)的准确性。方法选择2017年1月至2023年6月于海军军医大学(第二军医大学)第一附属医院行多参数磁共振扫描并行前列腺穿刺活检术取得病理证实的患者,对所有患者的血清总PSA(t-PSA)、游离PSA(f-PSA)、f-PSA与t-PSA比值(f/t PSA)及PI-RADS评分进行汇总。以穿刺病理结果作为金标准,分析在不同PSA水平下,PI-RADS评分在PCa诊断中的准确度。结果共计纳入2526例患者,根据PSA水平将患者分为7组:PSA≤4 ng/mL、4 ng/mL<PSA≤10 ng/mL(f/t PSA≥0.16)、4 ng/mL<PSA≤10 ng/mL(f/t PSA<0.16)、10 ng/mL<PSA≤20 ng/mL、20 ng/mL<PSA≤50 ng/mL、50 ng/mL<PSA≤100 ng/mL、>100 ng/mL。在全部患者中,PI-RADS评分≥3分诊断PCa灵敏度达90.0%,优于PI-RADS评分≥4分(灵敏度76.3%)。PSA≤4 ng/mL时,PI-RADS评分≥4分的准确度高于PI-RADS评分≥3分(87.7%vs 64.0%);随着PSA水平的升高,PI-RADS评分≥4分和PI-RADS评分≥3分的诊断准确度逐渐上升并趋同,在50 ng/m<PSA≤100 ng/mL时,两者的诊断准确度分别为90.7%和92.0%。结论在较高PSA水平时,PI-RADS评分诊断PCa的准确度更高,可减少患者的非必要穿刺。Objective To investigate the accuracy of prostate imaging and reporting data system(PI-RADS)score in diagnosing prostate cancer(PCa)with different prostate-specific antigen(PSA)levels.Methods Patients who underwent multiparametric magnetic resonance imaging scanning with biopsy of the prostate to obtain pathological confirmation in The First Affiliated Hospital of Naval Medical University(Second Military Medical University)between Jan.2017 and Jun.2023 were enrolled,and serum total PSA(t-PSA),free PSA(f-PSA),the ratio of free PSA to total PSA(f/t PSA)and PI-RADS scores were summarized in all patients.The accuracy of PI-RADS score in diagnosing PCa was analyzed at different PSA levels using pathology of the prostate biopsy as the gold standard.Results A total of 2526 patients were enrolled and categorized into 7 groups according to the PSA level:0-4 ng/mL,>4-10 ng/mL(f/t PSA≥0.16),>4-10 ng/mL(f/t PSA<0.16),>10-20 ng/mL,>20-50 ng/mL,>50-100 ng/mL,and>100 ng/mL.In all patients,the sensitivity of PI-RADS≥3 in diagnosing PCa was 90.0%,which was superior to PI-RADS≥4(sensitivity:76.3%).Among the patients with PSA≤4 ng/mL,the accuracy of PI-RADS≥4 in diagnosing PCa was higher than that of PI-RADS≥3(87.7%vs 64.0%).With the increase of PSA levels,the diagnostic accuracies of PI-RADS≥4 and PI-RADS≥3 were gradually increased and tended to be the same.When PSA was>50-100 ng/mL,the diagnostic accuracies of PI-RADS≥4 and≥3 were 90.7%and 92.0%,respectively.Conclusion At higher PSA levels,the accuracies of PI-RADS scores in diagnosing PCa are higher,which can reduce unnecessary puncture of patients.

关 键 词：前列腺肿瘤 前列腺影像报告和数据系统 前列腺特异性抗原 前列腺穿刺活检 准确度 

分 类 号：R737.25[医药卫生—肿瘤]