期刊
UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS
卷 32, 期 1, 页码 -出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.urolonc.2013.06.007
关键词
Clinically significant disease; Multiparametric MRI; negative biopsy; Template prostate mapping
资金
- Egyptian government
- Medical Research Council
- NIHR-HTA
- NIHR-i4i
- US NIH/NCI
- Pelican Cancer Foundation
- Prostate Cancer UK
- St Peter's Trust
- UK National Institute of Health Research UCLH/UCL Comprehensive Biomedical Research Centre, London, UK
- MRC [G0701302, G1002509] Funding Source: UKRI
- Medical Research Council [G0701302, G1002509] Funding Source: researchfish
- National Institute for Health Research [ACF-2010-20-002] Funding Source: researchfish
- Pelican Cancer Foundation [1305] Funding Source: researchfish
Purpose: To assess the performance of multiparametric magnetic resonance imaging (mp-MR1) in patients with previous negative transrectal ultrasound (TRUS) guided prostate biopsy. Materials and methods: Fifty-four patients with at least 1 previous negative TRUS prostate biopsy underwent mp-MR1 in the form of T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging. This was followed by transperineal template systematic prostate biopsies. Analysis was done based on 2 sectors per prostate, right and left (108 sectors out of 54 prostates). mp-MRI was scored using an ordinal scale 1 to 5 based on the suspicion of the presence of clinically significant disease. We used 6 different definitions for clinically significant disease and tested the performance of mp-MRI at each single definition. Results: Median age was 64 (range, 39-75), median PSA level was 10 (range, 2-23), and median number of biopsies was 45 (range, 21-137). Cancer of any volume and any grade was detected in 34 of 54 (63%) patients. mp-MRI accuracy at detection of clinically significant cancer using University College London (UCL) definition 2 (any Gleason score of 4 or maximum cancer core length of >4 mm or both) showed sensitivity of 76%, specificity of 42%, positive predictive value of 38%, and negative predictive value of 79%. For a different definition of significant tumor (1/CL, definition 1, dominant Gleason score 4 or maximum cancer core length >6 mm or both), the sensitivity was 90%, specificity 42%, positive predictive value 26%, and negative predictive value 95%. Conclusions: mp-MR1 showed good performance at both detection and ruling out clinically significant disease, according to the definition used nip-MR1 can then be used as a triage test in the population with persistently elevated or rising PSA levels to select patients that can avoid unnecessary prostate biopsy. (C) 2014 Elsevier Inc. All rights reserved.
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