以3T多參數磁振造影診斷前列腺癌的陽性預測值
盧顥文、童敏哲、戴浩平、陳祥來、謝肇新、黃鐘銘、翁瑋駿、黃立華、李毅彥、許兆畬
Positive predictive value of multiparametric magnetic Resonance Imaging in prostate cancer detection: The experience of Tungs’ Taichung MetroHarbor Hospital
Hao-wen, LU, Min-Che Tung, Hao-Ping Tai, Hsiang-Lai Chen, Siu-San Tse, Zhon-Min Huang, Wei-Chun Weng, Li-Hua Huang, I-Yen Lee, Chao-Yu Hsu
Divisions of Urology, Department of Surgery, Tungs’Taichung MetroHarbor Hospital, Taichung, Taiwan
Purpose: Prostate cancer is the 5th common cancer among male in Taiwan. It typically diagnosed by trans-rectal ultrasound (TRUS) biopsy in patients who had elevated serum prostate specific antigen and abnormal digital rectal examination (DRE). However TRUS guided biopsy can bring serious complications including urosepsis and unpleasant experiences to patients. 3tesla (3T) multiparametric magnetic resonance imaging (mp-MRI) is an optional tool for imaging prostate with high negative predictive value in active surveillance. We performed a 5 year retrospective analysis to assess the positive predictive value of prostate cancer by 3T mp-MRI with head to head comparison.
Materials and Methods: From January 2012 to December 2016, 171 cases of radical prostatectomy were performed in Tungs’Taichung MetroHarbor Hospital. 149 cases had pathology report by TRUS biopsy confirmed prostate cancer before operation. 22 cases without pathology proved but still clinically suspected prostate cancer due to abnormal PSA value and DRE. 3T mp-MRI was performed for further diagnosis and all cases underwent radical prostatectomy later.
Results: In all 22 cases, 5 cases in 3T mp-MRI report were suspected benign prostate hyperplasia however abnormal T2 weight image was found with local increased (Cho+Cr)/Cit ratio. 18 cases were suspected prostate cancer. The pathology reports were based on whole-mount prostate sections. 12 cases were confirmed prostate cancer and 4 cases were high-grade prostatic intraepithelial neoplasia (HGPIN). The positive predictive value of mp-MRI was calculated.
Conclusion: The clinical positive predictive value of mp-MRI is 54.5% for prostate cancer. Combined prostate cancer with HGPIN, the positive predictive value can up to 72.7%. 3T mp-MRI can detect clinically significant prostate cancer with high accuracy. However, the image reading pending on interpreting skills.