The diagnostic accuracy of multiparametric magnetic resonance imaging before biopsy in the detection of prostate cancer.

Autor: Otti, Vanessa C., Miller, Catherine, Powell, Roy J., Thomas, Richard M., McGrath, John S.
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Zdroj: BJU International; Jan2019, Vol. 123 Issue 1, p82-90, 9p
Abstrakt: Objectives: To determine the extent to which clinically significant prostate cancer (csPCa) can be detected in a routine National Health Service setting in men with no previous biopsy, when multiparametric magnetic resonance imaging (mpMRI) is introduced into the diagnostic pathway. Patients and Methods: In all, 1 090 mpMRIs were performed between July 2013 and April 2016 in biopsy‐naïve men with an abnormal prostate‐specific antigen level and/or digital rectal examination. Data were collected from patient records at the Royal Devon and Exeter NHS Foundation Trust. mpMRI Prostate Imaging Reporting and Data System (PI‐RADS) scores were compared to transperineal or transrectal ultrasonography (TRUS)‐guided biopsy findings as the reference standard. csPCa was defined as Gleason score of ≥3+4. The diagnostic accuracy of mpMRI was also assessed. Results: The mpMRI was interpretable in 1 023 men and 792 underwent biopsy, of which 106 were transperineal. The median number of cores taken in transperineal and TRUS‐guided biopsy were 10 and 6, respectively. The detection rate of csPCa was 37%; csPCa rose from 15% of PI‐RADS 1 and 2 to 86% of PI‐RADS 5. The sensitivity, negative predictive value, specificity, and positive predictive value were 82%, 85%, 59% and 54%, respectively. The study is limited by its retrospective nature and lack of reporting of follow‐up for 'missed cancers'. Men with low mpMRI PI‐RADS were also less likely to undergo biopsy. Whilst this selection bias may overestimate the detection rate of csPCa, this reflects the shared decisions patients and clinicians make in day‐to‐day practice outside of research centres. Conclusion: In a routine clinical setting, the higher the mpMRI PI‐RADS, the greater the detection rate of csPCa in biopsy‐naïve men. A normal mpMRI does not exclude csPCa; however, mpMRI may have utility in informing shared‐decision making on whether to proceed to biopsy and subsequent treatment. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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