振造影對於攝護腺癌病理結果預測的影響-中國醫經驗分享
周聖峰、謝博帆、黃志平、吳錫金、葉進仲、楊啟瑞、陳冠亨、張議徽、黃煒軒、李聖偉、賴俊佑、張菡、林維卿、張兆祥
中國醫藥大學附設醫院泌尿部
Pathological staging prediction rate of mpMRI in prostate cancer- CMUH experience
Shen-Feng Chou, Po-Fan Hsieh, Chi-Ping Huang, Hsi-Chin Wu, Chin-Chung Yeh, Chi-Rei Yang, Guan-Heng Chen, Yi-Huei Chang, Wei-Hsuan Huang, Sheng-Wei Li, Chun-Yu Lai, Han Chang, Wei-Ching Lin, Chao-Hsiang Chang
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Objectives:
To assess the accuracy of mpMRI in detection of significant prostate cancer in men undergoing robotic-assisted radical prostatectomy (RARP) at a single institution and to assess concordance between mpMRI and RP for local tumor staging and index lesion locations. The study aimed to analyze the diagnostic performance of preoperative mp-MRI in detection of significant prostate cancer in men undergoing robotic-assisted radical prostatectomy (RARP) at a single institution. Compare suspected location of prostate cancer mpMRI to postoperative histological examination, and determine the most sensitive pulse sequence from the mp-MRI protocol in estimating the local extent of PCa.
Materials and Methods
A retrospective analysis of patients treated as RARP who underwent preoperative MRI from AUG 2012 to SEP 2018. We excluded patients with bone metastatic lesion, concurrent UBUC under BCG treatment and conduct MRI without multiparameter. The results of mpMRI were compared with the final RARP specimen to analyse the performance of mpMRI for significant prostate cancer detection, index lesion localization, and prediction of T3 disease. A comparison between mpMRI cases performed using the technical and reporting specifications of PI‐RADS version 1 and version 2 was also performed.
Results
A total of 285 cases were included for analysis. MpMRI PI‐RADS score ≥3 had a 81% sensitivity and 91% positive predictive value (PPV) for significant prostate cancer at RARP. The concordance between index lesion location on mpMRI and RP specimen was 75%. The sensitivity for predication of significant prostate cancer with index lesion was higher in the PI‐RADS 2 (154 cases) compared with PI‐RADS version 1 (131 cases) (84 vs 70%, p=0.031). In extraprostatic disease, mpMRI had a 88% sensitivity, 92% specificity.
Conclusions
In patients undergoing RARP with pre-OP mpMRI is highly predictive (91% PPV) of significant prostate cancer, with an index lesion concordance of 75%. However; further study is required to determine if this is attributable to improved experience with mpMRI or changes in the PI‐RADS system.