专家解读双参数-MRI 与非专家解读多参数-MRI 在检测具有临床意义的前列腺癌方面的一致性：临床意义。

IF 2.3 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer Pub Date : 2024-10-05 DOI:10.1016/j.clgc.2024.102233

Nahuel Paesano , María José Gutiérrez Vallecillo , Violeta Catalá , Larisa Tcholakian , Xavier Alomar , Miguel Barranco , Abel González-Huete , Jonathan Hernández Mancera , Enric Trilla , Juan Morote

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引用次数: 0

摘要

目的：前列腺磁共振成像（MRI）的解读具有挑战性，专业知识起着至关重要的作用。与多参数磁共振成像（mpMRI）相比，双参数磁共振成像（bpMRI）具有时间和成本优势，因此在经验丰富的中心越来越受欢迎。我们旨在分析非专家放射科医师的 mpMRI PI-RADS 与专家放射科医师的 bpMRI PI-RADS 之间的一致性及其临床意义。材料与方法：222 名疑似患有前列腺癌（PCa）且非专家放射科医师报告了 mpMRI 的男性被转诊至参考中心进行经会阴部 MRI-TRUS 融合活检，由专家放射科医师报告 bpMRI PI-RADS 2.1 和分割，并对外部 mpMRI 进行盲检。针对可疑病灶进行绘图，并进行 12 核系统性活检。当ISUP分级组≥2时，诊断为有临床意义的PCa（csPCa）：49.1%的病例（Kappa指数为0.288）两种PI-RADS之间存在一致性。在 102 个病例（45.9%）中，专家将其重新分类为较低的 PI-RADS，而在 11 个病例（5.0%）中，专家将其重新分类为较高的 PI-RADS，P < .001。30.8% 的非专家 PI-RADS 3、43.6% 的 PI-RADS 4 和 83.7% 的 PI-RADS 5 达成了一致，P < .001。潜在的临床意义包括：与非专家 mpMRI 读数相比，使用专家 bpMRI 读数时前列腺活检减少 27%（P < 0.001），而未检测到的 csPCa 分别为 4.2% 和 3.4%，P = .669。未发现的 PCa 的过度检测率分别为 29.4% 和 0%，P = .034：非专家 PI-RADS mpMRI 与专家 PI-RADS bpMRI 之间的一致性较低，随着非专家 PI-RADS 的增加而增加。专家重新分类将减少四分之一以上的前列腺活检和 iPCa 的过度检测，而 csPCa 的检测则保持相似。

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Concordance Between the Expert Reading of Biparametric-MRI and the Nonexpert Multiparametric-MRI for the Detection of Clinically Significant Prostate Cancer: Clinical Implications

Purpose

Prostate-magnetic resonance imaging (MRI) interpretation is challenging, with expertise playing a crucial role. Biparametric MRI (bpMRI) is gaining popularity in experienced centers due to its time and cost advantages over multiparametric MRI (mpMRI). We aim to analyze concordance between nonexpert radiologist PI-RADS from mpMRI and expert radiologist PI-RADS from bpMRI, and its clinical implications.

Material and Methods

222 men suspected of having prostate cancer (PCa) and mpMRI reported by nonexpert radiologists were referred to a reference center for transperineal MRI-TRUS fusion biopsy where an expert radiologist reported bpMRI PI-RADS 2.1 and segmentation, blinded to external mpMRI. Mapping targeted suspected lesions and 12-core systematic biopsies were performed. Clinically significant PCa (csPCa) was diagnosed when ISUP-grade group was ≥2.

Results

Concordance between both PI-RADS existed in 49.1% of cases (Kappa index 0.288). In 102 cases (45.9%), expert reclassification to lower PI-RADS existed, while an increase existed in 11 cases (5.0%), P < .001. Agreement existed in 30.8% of nonexpert PI-RADS 3, 43.6% of PI-RADS 4, and 83.7% of PI-RADS 5, P < .001. Potential clinical implications included 27% reduction in prostate biopsies when using expert bpMRI readings compared to nonexpert mpMRI readings (P < 0.001), while undetected csPCa were 4.2% and 3.4%, respectively, P = .669. Over-detection reduction of insignificant PCa was 29.4% and 0%, respectively, P = .034.

Conclusions

Concordance between nonexpert PI-RADS mpMRI and expert PI-RADS bpMRI was low, increasing with nonexpert PI-RADS. Expert reclassification would reduce prostate biopsies by more than one quarter and over-detection of iPCa, while csPCa detection remained similar.

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.