摘要
目的:探讨多参数磁共振(mp-MRI)对前列腺癌病灶诊断的敏感性,并分析影响敏感性的因素。方法:回顾性分析2017年8月至2019年7月北京医院收治的66例行根治性前列腺切除术患者的病例资料。中位年龄67(56~80)岁。中位术前PSA 8.73(1.22~72.46)ng/ml。中位前列腺体积35.9(16.8~131.8)ml。所有患者术前均行mp-MRI检查,术后前列腺标本制作病理大切片。2名放射科医生和1名病理科医生分别对前列腺癌病灶进行诊断和定位,以患者和病灶为研究对象分别进行研究,主要研究终点为mp-MRI对前列腺癌诊断的敏感性,分析mp-MRI诊断敏感性的影响因素。结果:本组66例,术前mp-MRI诊断前列腺癌62例(93.9%)。术后病理检查共检出病灶109处,术前mp-MRI共检出77处,敏感性为70.6%。术后病理分级分组(ISUP)分别为1组53例(48.6%),2组31例(27.5%),3组19例(17.4%),≥4组6例(5.5%)。对mp-MRI假阴性病灶特点进行分析,mp-MRI对肿瘤最大径线>1 cm[92.5%(62/67)]、Gleason评分≥7分[87.5%(49/56)],以及前列腺内的主要病灶[89.4%(59/66)]敏感性更高(P<0.01)。多因素logistic回归分析结果显示,肿瘤最大径线>1 cm(OR=3.183,95%CI 1.580~6.411,P=0.001)以及肿瘤主要病灶(OR=4.042,95%CI 1.127~14.503,P=0.032)是mp-MRI正确诊断前列腺癌的独立影响因素。结论:mp-MRI是诊断前列腺癌可靠而有效的手段,对Gleason评分≥7分、肿瘤最大径线>1 cm以及肿瘤主要病灶具有较高敏感性,其中前列腺癌病灶的大小以及肿瘤是否为主要病灶是mp-MRI诊断敏感性的独立影响因素。
Objective To investigate the detection rate and the characteristics of detected prostate cancer foci on multi-parametric MRI(mp-MRI)and to evaluate the potential influence factors.Methods A total of 66 patients undergoing radical prostatectomy(RP)from August 2017 to July 2019 in Beijing Hospital were retrospectively studied.The median age was 67(56-80)years,with the median preoperative PSA level of 8.73(1.22-72.46)ng/ml,and median prostate volume of 35.9(16.8-131.8)ml.All patients underwent mp-MRI before surgery and the whole mount section of RP specimens was prepared.Two radiologists reviewed all the foci independently and then matched each foci with an urological pathologist.The primary outcome was the detection rate of prostate cancer.The potential influence factors were also investigated.Results Of all 66 patients,a total of 62(93.9%)patients were diagnosed with prostate cancer on a preoperative mp-MRI.On whole mount section,109 prostate cancer foci were detected,of which 77 foci were correctly diagnosed on mp-MRI,with the overall sensitivity of 70.6%.For all the foci detected,53(48.6%)were grade group 1 disease of International Society of Urological pathology(ISUP),31(27.5%)were ISUP grade group 2 disease,19(17.4%)were ISUP grade group 3 disease,and 6(5.5%)were≥ISUP grade group 4 disease.Mp-MRI detected 62/67(92.5%)lesions with tumor diameter≥1 cm,49/56(87.5%)lesions with tumor Gleason score≥7,and 59/66(89.4%)index lesions.The tumor diameter(OR=3.183,95%CI 1.580-6.411,P=0.001)and index lesion status(OR=4.042,95%CI 1.127-14.503,P=0.032)were independently associated with the detection of prostate cancer foci on mp-MRI.Conclusions mp-MRI is an effective technique for prostate cancer detection.Sensitivity increased with increased tumor size and index lesion status.The tumor diameter and index lesion status were independently associated with the detection of prostate cancer foci on mp-MRI.
作者
王淼
王萱
侯惠民
崔亚东
张伟
孟令峰
李春媚
王建业
刘明
Wang Miao;Wang Xuan;Hou Huimin;Cui Yadong;Zhang Wei;Meng Lingfeng;Li Chunmei;Wang Jianye;Liu Ming(Department of Urology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;graduate students of Graduate School of Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2020年第10期746-751,共6页
Chinese Journal of Urology
基金
国家重点研发计划(2017YFC0840100、2017YFC0840102)
首都临床特色应用研究(Z171100001017201)
北京医院"121工程"项目(BJ-2015-138)
北京市自然科学基金项目(7194315)。
关键词
前列腺肿瘤
多参数磁共振
影像诊断
病理大切片
Prostate neoplasm
Magnetic resonance imaging
Imaging diagnosis
Whole mount section
