目的研究多参数磁共振成像(multiparameter magnetic resonance imaging,mpMRI)与超声融合导航技术在前列腺靶向穿刺中的临床价值。方法以2018年5月至2019年1月就诊于天津市第一中心医院且经mpMRI诊断后发现的40例前列腺癌疑似患者作为...目的研究多参数磁共振成像(multiparameter magnetic resonance imaging,mpMRI)与超声融合导航技术在前列腺靶向穿刺中的临床价值。方法以2018年5月至2019年1月就诊于天津市第一中心医院且经mpMRI诊断后发现的40例前列腺癌疑似患者作为研究对象,将mpMRI与超声融合导航技术应用于患者前列腺靶向穿刺活检,同时进行12针系统性穿刺活检,并对穿刺病理结果进行观察和分析。结果40例前列腺癌疑似患者中,靶向穿刺及前列腺系统穿刺确诊27例,阳性率为67.50%。靶向穿刺确诊患者21例(52.50%),系统穿刺确诊患者18例(45.00%),两种穿刺方法的确诊率差异无统计学意义(P=0.607)。系统穿刺的单针阳性率为14.41%(69/479),靶向穿刺的单针阳性率为47.57%(49/103),差异有统计学意义(P<0.05)。靶向穿刺以及系统穿刺均显示为阳性的12例患者中,有5例患者的靶向穿刺Gleason评分比系统穿刺更高。结论MRI与超声融合导航技术在前列腺靶向穿刺的应用具有较高价值,能够以较少的穿刺针数检出高危的前列腺癌,同时联合系统穿刺,可提高前列腺癌穿刺活检的阳性检出率,同时减少高Gleason评分的前列腺癌患者的漏诊率。联合应用前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)评分,靶向穿刺可提高有临床意义的前列腺癌检出率,有助于减少高危前列腺癌患者的漏诊。展开更多
目的:多参数磁共振成像(multiparametric magnetic resonance imaging, mpMRI)联合血清碱性磷酸酶(alkaline phosphatase, ALP)、D-二聚体(D-dimer, DD2)、纤维蛋白原(fibrinogen, FIB)诊断前列腺癌骨转移的效能分析。方法:对169例前列...目的:多参数磁共振成像(multiparametric magnetic resonance imaging, mpMRI)联合血清碱性磷酸酶(alkaline phosphatase, ALP)、D-二聚体(D-dimer, DD2)、纤维蛋白原(fibrinogen, FIB)诊断前列腺癌骨转移的效能分析。方法:对169例前列腺癌患者的临床资料进行回顾性收集和分析,根据骨扫描的检查结果辅以核磁共振,将盆腔有无骨转移的病人分为前列腺癌骨转移组80例和非骨转移组89例。所有患者在手术前都接受了MRI检查,对血清PSA、ALP、D-二聚体、FIB水平进行定量检测。对不同影像指标与前列腺癌骨转移结果之间的一致性采用Kappa一致性检验;利用单因素和多因素Logistic回归分析,评估mpMRI、ALP、D-二聚体、FIB及其他临床指标在前列腺癌骨转移诊断中的价值。利用受试者工作特征(receiver operating characteristic, ROC)曲线对前列腺癌骨转移中纳入的mpMRI、ALP、D-二聚体、FIB及其联合指标的临床应用价值进行评价。结果:T1WI、T2WI压脂、DWI及mpMRI与前列腺癌骨转移结果比较的Kappa值分别为0.536、0.470、0.629、0.691 (P Objective: To analyze the efficacy of multiparametric MRI (mpMRI) combined with serum ALP, D-dimer, and FIB in the diagnosis of bone metastasis in prostate cancer. Methods: A retrospective collection and analysis of clinical data from 169 prostate cancer patients were conducted. Based on the results of bone scans supplemented by MRI, patients with or without pelvic bone metastasis were divided into the prostate cancer bone metastasis group (80 cases) and the non-bone metastasis group (89 cases). All patients underwent MRI examination prior to surgery, and serum levels of PSA, ALP, D-dimer, and FIB were quantitatively measured. Kappa consistency tests were used to analyze the agreement between different imaging indicators and the results of prostate cancer bone metastasis. Uni- and multivariable logistic regression analyses were performed to evaluate the value of mpMRI, ALP, D-dimer, FIB, and other clinical indicators in the diagnosis of prostate cancer bone metastasis. The clinical application value of mpMRI, ALP, D-dimer, FIB, and their combined indicators in diagnosing prostate cancer bone metastasis was assessed using receiver operating characteristic (ROC) curves. Results: The Kappa values comparing T1WI, T2WI fat suppression, DWI, and mpMRI with the results of prostate cancer bone metastasis were 0.536, 0.470, 0.629, and 0.691, respectively (P < 0.001). Compared to the non-bone metastasis group, the serum levels of ALP, D-dimer, and FIB in the bone metastasis group were significantly higher (P < 0.001). Multivariable logistic regression analysis indicated that mpMRI, ALP, D-dimer, and FIB are independent risk factors for prostate cancer bone metastasis (P < 0.05). The combined indicators showed the best performance, followed by the individual indicators of D-dimer, mpMRI, ALP, and FIB, all of which demonstrated good diagnostic value (P < 0.05). Conclusion: mpMRI, ALP, D-dimer, and FIB all demonstrate certain diagnostic efficacy for prostate cancer bone metastasis. The combined use of these indicators can further enhance diagnostic value, suggesting that they should be considered for broader application in clinical practice.展开更多
目的:探索早发性前列腺癌的临床病理特征;建立并验证年轻男性前列腺穿刺结果的预测模型。方法:回顾性分析2011—2021年在四川大学华西医院行前列腺穿刺活检术的213例≤50岁男性的临床影像资料,以探索与早发性前列腺癌发生相关的预测因...目的:探索早发性前列腺癌的临床病理特征;建立并验证年轻男性前列腺穿刺结果的预测模型。方法:回顾性分析2011—2021年在四川大学华西医院行前列腺穿刺活检术的213例≤50岁男性的临床影像资料,以探索与早发性前列腺癌发生相关的预测因素。美国SEER数据库中4608例同时期早发性前列腺癌患者的数据被获取,并用于比较东西方早发性前列腺癌患者的临床病理差异。129例具有基于多参数磁共振成像(multi-parametric MRI,mpMRI)的前列腺影像报告和数据系统(prostate imaging reporting and data system,PIRADS)评分及表观弥散系数(apparent diffusion coefficient,ADC)值的患者被随机分配至训练组(91例)和验证组(38例),分别用于早发性前列腺癌预测模型的构建和验证。单因素和多因素logistic回归分析被用于模型建立。模型通过列线图进行可视化展示并通过受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线以及决策曲线分析进行验证。结果:本研究所纳入患者的中位年龄为46岁。最终46例(21.6%,46/213)检出前列腺癌。相较SEER数据库人群,本中心的早发性前列腺癌患者具有显著更高的中位前列腺特异性抗原(prostate-specific antigen,PSA)(14.2 ng/mL vs 5.7 ng/mL,P<0.001)、初诊骨转移占比(34.1%vs 4.6%,P<0.001)以及国际泌尿病理学会(International Society of Urological Pathology,ISUP)4~5级占比(46%vs 8%,P<0.001)。多因素logistic回归分析结果显示,年龄(OR=1.323,95%CI:1.111~1.649,P=0.005)、前列腺特异性抗原密度(PSAD)(OR=1.718,95%CI:1.058~3.108,P=0.038)、PIRADS 4分(OR=26.632,95%CI:3.572~584.050,P=0.006)、PIRADS 5分(OR=46.789,95%CI:5.548~1[KG0.5mm]107.801,P=0.002)以及ADC值(OR=0.995,95%CI:0.991~0.999,P=0.021)是早发性前列腺癌的独立预测因素。上述临床影像参数被用于预测模型的构建。在内部验证中,模型的ROC曲线AUC值为0.842。在校准曲线以及决策曲线分析中,模型亦具有良好表现。结论:本研究构建了预测年轻男性罹患早发性前列腺癌的模型,若能在未来大样本的外部队列中得到有效验证,这一模型将有望成为辅助前列腺穿刺抉择的工具。展开更多
Background:At present,biopsy is essential for the diagnosis of prostate cancer(PCa)before radical prostatectomy(RP).However,with the development of prostate-specific membrane antigen positron emission tomography/compu...Background:At present,biopsy is essential for the diagnosis of prostate cancer(PCa)before radical prostatectomy(RP).However,with the development of prostate-specific membrane antigen positron emission tomography/computed tomography(PSMA PET/CT)and multiparametric magnetic resonance imaging(mpMRI),it might be feasible to avoid biopsy before RP.Herein,we aimed to explore the feasibility of avoiding biopsy before RP in patients highly suspected of having PCa after assessment of PSMA PET/CT and mpMRI.Methods:Between December 2017 and April 2022,56 patients with maximum standardized uptake value(SUVmax)of≥4 and Prostate Imaging Reporting and Data System(PI-RADS)≥4 lesions who received RP without preoperative biopsy were enrolled from two tertiary hospitals.The consistency between clinical and pathological diagnoses was evaluated.Preoperative characteristics were compared among patients with different pathological types,T stages,International Society of Urological Pathology(ISUP)grades,and European Association of Urology(EAU)risk groups.Results:Fifty-five(98%)patients were confirmed with PCa by pathology,including 49(89%)with clinically significant prostate cancer(csPCa,defined as ISUP grade≥2 malignancy).One patient was diagnosed with high-grade prostatic intraepithelial neoplasia(HGPIN).CsPCa patients,compared with clinically insignificant prostate cancer(cisPCa)and HGPIN patients,were associated with a higher level of prostate-specific antigen(22.9 ng/mL vs.10.0 ng/mL,P=0.032),a lower median prostate volume(32.2 mL vs.65.0 mL,P=0.001),and a higher median SUVmax(13.3 vs.5.6,P<0.001).Conclusions:It might be feasible to avoid biopsy before RP for patients with a high probability of PCa based on PSMA PET/CT and mpMRI.However,the diagnostic efficacy of csPCa with PI-RADS≥4 and SUVmax of≥4 is inadequate for performing a procedure such as RP.Further prospective multicenter studies with larger sample sizes are necessary to confirm our perspectives and establish predictive models with PSMA PET/CT and mpMRI.展开更多
目的探讨多参数磁共振(mpMRI)-经直肠超声(TRUS)影像认知融合引导下前列腺靶向穿刺联合系统穿刺活检术在诊断前列腺癌方面的可行性及有效性。方法选取2020年3月至2022年3月在阳江市人民医院首次行前列腺穿刺活检的患者111例,随机分组,...目的探讨多参数磁共振(mpMRI)-经直肠超声(TRUS)影像认知融合引导下前列腺靶向穿刺联合系统穿刺活检术在诊断前列腺癌方面的可行性及有效性。方法选取2020年3月至2022年3月在阳江市人民医院首次行前列腺穿刺活检的患者111例,随机分组,观察组56例,对照组55例。观察组患者行mpMRI-TRUS影像认知融合引导下前列腺靶向穿刺联合系统性穿刺术,对照组患者单纯行12针TRUS引导下系统性穿刺活检术。比较两组患者在总体穿刺阳性率、有临床意义前列腺癌的检出率、漏诊率、单针阳性率、标本肿瘤组织长度、标本癌占比、并发症及在二次穿刺、经尿道前列腺剜除或根治术后病理升级的例数等方面的差异。结果两组患者在年龄、直肠指检阳性率、前列腺体积、前列腺特异性抗原(PSA)、穿刺针数、mpMRI前列腺影像报告和数据评分系统(PI-RADS)及术后并发症方面差异均无统计学意义。但观察组在总体穿刺阳性率(50.0% vs 27.3%,P=0.014)、有临床意义前列腺癌的检出率(50.0% vs 25.5%,P=0.008)及单针阳性率(26.8% vs 16.0%,P<0.001)方面明显高于对照组。此外,观察组病理标本还表现出更长的肿瘤组织长度[(8±4)mm vs (4±3)mm,P=0.001]、更高的癌占比[(64.5±20.7)% vs (40.0±23.8)%,P=0.002],更低的漏诊率(0% vs 25.0%,P=0.021),以及出现更少的二次穿刺、经尿道前列腺剜除或根治术后病理升级的情况(0例vs 8例,P=0.009)。结论mpMRI-TRUS影像认知融合引导下前列腺靶向穿刺联合系统穿刺活检术能明显提高总体穿刺阳性率及有临床意义前列腺癌的检出率,降低前列腺癌穿刺活检的漏诊率,同时还能减少二次穿刺、经尿道前列腺剜除或根治术后病理升级的情况,且操作简单、便捷、安全,适合临床推广。展开更多
文摘目的研究多参数磁共振成像(multiparameter magnetic resonance imaging,mpMRI)与超声融合导航技术在前列腺靶向穿刺中的临床价值。方法以2018年5月至2019年1月就诊于天津市第一中心医院且经mpMRI诊断后发现的40例前列腺癌疑似患者作为研究对象,将mpMRI与超声融合导航技术应用于患者前列腺靶向穿刺活检,同时进行12针系统性穿刺活检,并对穿刺病理结果进行观察和分析。结果40例前列腺癌疑似患者中,靶向穿刺及前列腺系统穿刺确诊27例,阳性率为67.50%。靶向穿刺确诊患者21例(52.50%),系统穿刺确诊患者18例(45.00%),两种穿刺方法的确诊率差异无统计学意义(P=0.607)。系统穿刺的单针阳性率为14.41%(69/479),靶向穿刺的单针阳性率为47.57%(49/103),差异有统计学意义(P<0.05)。靶向穿刺以及系统穿刺均显示为阳性的12例患者中,有5例患者的靶向穿刺Gleason评分比系统穿刺更高。结论MRI与超声融合导航技术在前列腺靶向穿刺的应用具有较高价值,能够以较少的穿刺针数检出高危的前列腺癌,同时联合系统穿刺,可提高前列腺癌穿刺活检的阳性检出率,同时减少高Gleason评分的前列腺癌患者的漏诊率。联合应用前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)评分,靶向穿刺可提高有临床意义的前列腺癌检出率,有助于减少高危前列腺癌患者的漏诊。
文摘目的:多参数磁共振成像(multiparametric magnetic resonance imaging, mpMRI)联合血清碱性磷酸酶(alkaline phosphatase, ALP)、D-二聚体(D-dimer, DD2)、纤维蛋白原(fibrinogen, FIB)诊断前列腺癌骨转移的效能分析。方法:对169例前列腺癌患者的临床资料进行回顾性收集和分析,根据骨扫描的检查结果辅以核磁共振,将盆腔有无骨转移的病人分为前列腺癌骨转移组80例和非骨转移组89例。所有患者在手术前都接受了MRI检查,对血清PSA、ALP、D-二聚体、FIB水平进行定量检测。对不同影像指标与前列腺癌骨转移结果之间的一致性采用Kappa一致性检验;利用单因素和多因素Logistic回归分析,评估mpMRI、ALP、D-二聚体、FIB及其他临床指标在前列腺癌骨转移诊断中的价值。利用受试者工作特征(receiver operating characteristic, ROC)曲线对前列腺癌骨转移中纳入的mpMRI、ALP、D-二聚体、FIB及其联合指标的临床应用价值进行评价。结果:T1WI、T2WI压脂、DWI及mpMRI与前列腺癌骨转移结果比较的Kappa值分别为0.536、0.470、0.629、0.691 (P Objective: To analyze the efficacy of multiparametric MRI (mpMRI) combined with serum ALP, D-dimer, and FIB in the diagnosis of bone metastasis in prostate cancer. Methods: A retrospective collection and analysis of clinical data from 169 prostate cancer patients were conducted. Based on the results of bone scans supplemented by MRI, patients with or without pelvic bone metastasis were divided into the prostate cancer bone metastasis group (80 cases) and the non-bone metastasis group (89 cases). All patients underwent MRI examination prior to surgery, and serum levels of PSA, ALP, D-dimer, and FIB were quantitatively measured. Kappa consistency tests were used to analyze the agreement between different imaging indicators and the results of prostate cancer bone metastasis. Uni- and multivariable logistic regression analyses were performed to evaluate the value of mpMRI, ALP, D-dimer, FIB, and other clinical indicators in the diagnosis of prostate cancer bone metastasis. The clinical application value of mpMRI, ALP, D-dimer, FIB, and their combined indicators in diagnosing prostate cancer bone metastasis was assessed using receiver operating characteristic (ROC) curves. Results: The Kappa values comparing T1WI, T2WI fat suppression, DWI, and mpMRI with the results of prostate cancer bone metastasis were 0.536, 0.470, 0.629, and 0.691, respectively (P < 0.001). Compared to the non-bone metastasis group, the serum levels of ALP, D-dimer, and FIB in the bone metastasis group were significantly higher (P < 0.001). Multivariable logistic regression analysis indicated that mpMRI, ALP, D-dimer, and FIB are independent risk factors for prostate cancer bone metastasis (P < 0.05). The combined indicators showed the best performance, followed by the individual indicators of D-dimer, mpMRI, ALP, and FIB, all of which demonstrated good diagnostic value (P < 0.05). Conclusion: mpMRI, ALP, D-dimer, and FIB all demonstrate certain diagnostic efficacy for prostate cancer bone metastasis. The combined use of these indicators can further enhance diagnostic value, suggesting that they should be considered for broader application in clinical practice.
文摘目的:探索早发性前列腺癌的临床病理特征;建立并验证年轻男性前列腺穿刺结果的预测模型。方法:回顾性分析2011—2021年在四川大学华西医院行前列腺穿刺活检术的213例≤50岁男性的临床影像资料,以探索与早发性前列腺癌发生相关的预测因素。美国SEER数据库中4608例同时期早发性前列腺癌患者的数据被获取,并用于比较东西方早发性前列腺癌患者的临床病理差异。129例具有基于多参数磁共振成像(multi-parametric MRI,mpMRI)的前列腺影像报告和数据系统(prostate imaging reporting and data system,PIRADS)评分及表观弥散系数(apparent diffusion coefficient,ADC)值的患者被随机分配至训练组(91例)和验证组(38例),分别用于早发性前列腺癌预测模型的构建和验证。单因素和多因素logistic回归分析被用于模型建立。模型通过列线图进行可视化展示并通过受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线以及决策曲线分析进行验证。结果:本研究所纳入患者的中位年龄为46岁。最终46例(21.6%,46/213)检出前列腺癌。相较SEER数据库人群,本中心的早发性前列腺癌患者具有显著更高的中位前列腺特异性抗原(prostate-specific antigen,PSA)(14.2 ng/mL vs 5.7 ng/mL,P<0.001)、初诊骨转移占比(34.1%vs 4.6%,P<0.001)以及国际泌尿病理学会(International Society of Urological Pathology,ISUP)4~5级占比(46%vs 8%,P<0.001)。多因素logistic回归分析结果显示,年龄(OR=1.323,95%CI:1.111~1.649,P=0.005)、前列腺特异性抗原密度(PSAD)(OR=1.718,95%CI:1.058~3.108,P=0.038)、PIRADS 4分(OR=26.632,95%CI:3.572~584.050,P=0.006)、PIRADS 5分(OR=46.789,95%CI:5.548~1[KG0.5mm]107.801,P=0.002)以及ADC值(OR=0.995,95%CI:0.991~0.999,P=0.021)是早发性前列腺癌的独立预测因素。上述临床影像参数被用于预测模型的构建。在内部验证中,模型的ROC曲线AUC值为0.842。在校准曲线以及决策曲线分析中,模型亦具有良好表现。结论:本研究构建了预测年轻男性罹患早发性前列腺癌的模型,若能在未来大样本的外部队列中得到有效验证,这一模型将有望成为辅助前列腺穿刺抉择的工具。
基金supported by the National Key R&D Program of China(No.2022YFE0200800)the Key Project of Tianjin Municipal Science and Technology Commission(No.19ZXDBSY00050)+2 种基金the National Natural Science Foundation of China(Nos.81972400 and 82202962)the CAMS Initiative for Innovative Medicine(Nos.2022-I2M-1-008,2021-I2M-1-015,2022-I2M-2-002,and 2023-I2M-QJ-006)the Capital Health Research and Development of Special Funding(No.2022-1-4021).
文摘Background:At present,biopsy is essential for the diagnosis of prostate cancer(PCa)before radical prostatectomy(RP).However,with the development of prostate-specific membrane antigen positron emission tomography/computed tomography(PSMA PET/CT)and multiparametric magnetic resonance imaging(mpMRI),it might be feasible to avoid biopsy before RP.Herein,we aimed to explore the feasibility of avoiding biopsy before RP in patients highly suspected of having PCa after assessment of PSMA PET/CT and mpMRI.Methods:Between December 2017 and April 2022,56 patients with maximum standardized uptake value(SUVmax)of≥4 and Prostate Imaging Reporting and Data System(PI-RADS)≥4 lesions who received RP without preoperative biopsy were enrolled from two tertiary hospitals.The consistency between clinical and pathological diagnoses was evaluated.Preoperative characteristics were compared among patients with different pathological types,T stages,International Society of Urological Pathology(ISUP)grades,and European Association of Urology(EAU)risk groups.Results:Fifty-five(98%)patients were confirmed with PCa by pathology,including 49(89%)with clinically significant prostate cancer(csPCa,defined as ISUP grade≥2 malignancy).One patient was diagnosed with high-grade prostatic intraepithelial neoplasia(HGPIN).CsPCa patients,compared with clinically insignificant prostate cancer(cisPCa)and HGPIN patients,were associated with a higher level of prostate-specific antigen(22.9 ng/mL vs.10.0 ng/mL,P=0.032),a lower median prostate volume(32.2 mL vs.65.0 mL,P=0.001),and a higher median SUVmax(13.3 vs.5.6,P<0.001).Conclusions:It might be feasible to avoid biopsy before RP for patients with a high probability of PCa based on PSMA PET/CT and mpMRI.However,the diagnostic efficacy of csPCa with PI-RADS≥4 and SUVmax of≥4 is inadequate for performing a procedure such as RP.Further prospective multicenter studies with larger sample sizes are necessary to confirm our perspectives and establish predictive models with PSMA PET/CT and mpMRI.
文摘目的探讨多参数磁共振(mpMRI)-经直肠超声(TRUS)影像认知融合引导下前列腺靶向穿刺联合系统穿刺活检术在诊断前列腺癌方面的可行性及有效性。方法选取2020年3月至2022年3月在阳江市人民医院首次行前列腺穿刺活检的患者111例,随机分组,观察组56例,对照组55例。观察组患者行mpMRI-TRUS影像认知融合引导下前列腺靶向穿刺联合系统性穿刺术,对照组患者单纯行12针TRUS引导下系统性穿刺活检术。比较两组患者在总体穿刺阳性率、有临床意义前列腺癌的检出率、漏诊率、单针阳性率、标本肿瘤组织长度、标本癌占比、并发症及在二次穿刺、经尿道前列腺剜除或根治术后病理升级的例数等方面的差异。结果两组患者在年龄、直肠指检阳性率、前列腺体积、前列腺特异性抗原(PSA)、穿刺针数、mpMRI前列腺影像报告和数据评分系统(PI-RADS)及术后并发症方面差异均无统计学意义。但观察组在总体穿刺阳性率(50.0% vs 27.3%,P=0.014)、有临床意义前列腺癌的检出率(50.0% vs 25.5%,P=0.008)及单针阳性率(26.8% vs 16.0%,P<0.001)方面明显高于对照组。此外,观察组病理标本还表现出更长的肿瘤组织长度[(8±4)mm vs (4±3)mm,P=0.001]、更高的癌占比[(64.5±20.7)% vs (40.0±23.8)%,P=0.002],更低的漏诊率(0% vs 25.0%,P=0.021),以及出现更少的二次穿刺、经尿道前列腺剜除或根治术后病理升级的情况(0例vs 8例,P=0.009)。结论mpMRI-TRUS影像认知融合引导下前列腺靶向穿刺联合系统穿刺活检术能明显提高总体穿刺阳性率及有临床意义前列腺癌的检出率,降低前列腺癌穿刺活检的漏诊率,同时还能减少二次穿刺、经尿道前列腺剜除或根治术后病理升级的情况,且操作简单、便捷、安全,适合临床推广。
