前列腺癌查中的磁共振成像:系统性审查和元分析
Tamás Fazekas1,2,3, Sung Ryul Shim4, Giuseppe Basile5
1Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Vienna, Austria.
JAMA oncology
|April 5, 2024
概括
将前列腺MRI整合到癌症查中可以减少不必要的活检和过度诊断微不足道的前列腺癌 (PCa). 与仅针对PSA的查相比,这种方法保持了临床显著PCa (csPCa) 的检测.
科学领域:
- 在瘤学瘤学.
- 放射学 放射学是一门学科.
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
背景情况:
- 前列腺磁共振成像 (MRI) 越来越多地用于早期前列腺癌 (PCa) 检测.
- 目前的查依赖于前列腺特异性抗原 (PSA) 测试,往往导致过度诊断和不必要的活检.
研究的目的:
- 系统地评估MRI整合PCa查途径的证据.
- 将基于MRI的诊断价值与基于PSA的传统查进行比较.
主要方法:
- 随机临床试验和前性队列研究的系统审查和元分析.
- 包括12项涉及80,114名男性的研究,分析了对活检指示的数据,临床显著PCa (csPCa) 的检测率和不显著PCa的检测率.
- 使用混合效应模型,将MRI路径 (序列查,PI-RADS切线≥3或≥4) 与仅PSA查进行比较.
主要成果:
- 基于MRI的顺序查 (PI-RADS ≥3) 显示较高的csPCa检测几率 (OR 4.15) 但减少了活检率 (OR 0.28) 和微不足道的癌症检测 (OR 0.34) 与仅PSA查相比.
- 使用PI-RADS ≥4截止值进一步降低了微不足道的PCa检测 (OR 0.23) 和执行的活检 (OR 0.19),但没有影响cpca检测.
- 在MRI和PSA-only策略之间没有观察到cspca检测的显著差异 (PI-RADS≥3的OR为1.02).
结论:
- 将MRI整合到PCa查途径中可以显著减少不必要的活检和低级癌症的过度诊断.
- 与传统的PSA查相比,基于MRI的查有效地保持了临床显著PCa的检测率.
- 这些发现支持MRI作为优化前列腺癌早期检测策略的宝贵工具.
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