Less qualitative multiparametric magnetic resonance imaging in prostate cancer can underestimate extraprostatic extension in higher grade tumors.

IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY International Braz J Urol Pub Date : 2024-01-01 DOI:10.1590/S1677-5538.IBJU.2023.0321
Stephen Schmit, Sai Allu, Joshua Ray Tanzer, Rebecca Ortiz, Gyan Pareek, Elias Hyams
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Abstract

Background: Multiparametric magnetic resonance imaging (mpMRI) is increasingly used for risk stratification and preoperative staging of prostate cancer. It remains unclear how Grade Group (GG) interacts with the ability of mpMRI to determine the presence of extraprostatic extension (EPE) on surgical pathology.

Methods: A retrospective review of a robotic assisted laparoscopic radical prostatectomy (RALP) database from 2016-2020 was performed. Radiology mpMRI reports by multiple attending radiologists and without clear standardization or quality control were retrospectively assessed for EPE findings and compared with surgical pathology reports. The data were stratified by biopsy-based GG and a multivariable cluster analysis was performed to incorporate additional preoperative variables (age at diagnosis, PSA, etc.). Hazard ratios were calculated to determine how mpMRI findings and radiographic EPE relate to positive surgical margins.

Results: 289 patients underwent at least one mpMRI prior to RALP. Preoperative mpMRI demonstrated sensitivity of 39.3% and specificity of 88.8% for pathological EPE and had a negative predictive value (NPV) of 49.5%, and positive predictive value (PPV) of 84.0%. Stratification of NPV by GG yielded the following values: GG 1-5 (49.5%), GG 3-5 (40.8%), GG 4-5 (43.4%), and GG 5 (30.4%). Additionally, positive EPE on preoperative mpMRI was associated with a significantly decreased risk of positive surgical margins (RR: 0.655; 95% CI: 0.557-0.771).

Conclusions: NPV of prostate mpMRI for EPE may be decreased for higher grade tumors. A detailed reference reading and image quality optimization may improve performance. However, urologists should exercise caution in nerve sparing approaches in these patients.

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前列腺癌多参数磁共振成像的定性较低,可能会低估高级别肿瘤的睾丸外延伸。
背景:多参数磁共振成像(mpMRI多参数磁共振成像(mpMRI)越来越多地用于前列腺癌的风险分层和术前分期。目前仍不清楚等级组(GG)如何与 mpMRI 确定手术病理是否存在前列腺根治术后延伸(EPE)的能力相互影响:对2016-2020年机器人辅助腹腔镜前列腺癌根治术(RALP)数据库进行了回顾性研究。由多名放射科主治医师撰写的放射学 mpMRI 报告没有明确的标准化或质量控制,我们对 EPE 结果进行了回顾性评估,并与手术病理报告进行了比较。数据按基于活检的 GG 进行分层,并进行了多变量聚类分析,以纳入更多的术前变量(诊断时的年龄、PSA 等)。结果:289 名患者在接受 RALP 之前至少接受了一次 mpMRI 检查。术前 mpMRI 对病理 EPE 的敏感性为 39.3%,特异性为 88.8%,阴性预测值 (NPV) 为 49.5%,阳性预测值 (PPV) 为 84.0%。按 GG 对 NPV 进行分层得出以下数值:GG 1-5(49.5%)、GG 3-5(40.8%)、GG 4-5(43.4%)和 GG 5(30.4%)。此外,术前 mpMRI EPE 阳性与手术切缘阳性风险显著降低相关(RR:0.655;95% CI:0.557-0.771):结论:前列腺 mpMRI 检测 EPE 的 NPV 值可能会因肿瘤级别较高而降低。详细的参考阅片和图像质量优化可能会提高疗效。然而,泌尿科医生在对这些患者进行神经疏通时应谨慎行事。
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来源期刊
International Braz J Urol
International Braz J Urol UROLOGY & NEPHROLOGY-
CiteScore
4.60
自引率
21.60%
发文量
246
审稿时长
6-12 weeks
期刊介绍: Information not localized
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