学术和社区护理网络之间的PI-RADS评分的读者间可靠性和诊断准确性:差距有多大?
Shayan Smani1, Michael Jalfon1, Vinaik Sundaresan1
1Department of Urology, Yale University School of Medicine, New Haven, CT.
Urologic oncology
|October 22, 2024
概括
前列腺癌多参数MRI (mpMRI) 解释显示社区和学术中心之间的可靠性不佳,尽管诊断准确性相似. 这种变化,特别是在PI-RADS 3病变中,可能导致活检决策不一致,并影响患者的护理.
科学领域:
- 放射学 放射学是一门学科.
- 在瘤学瘤学.
- 医疗成像医学成像
背景情况:
- 前列腺成像报告和数据系统 (PI-RADS) 准则旨在标准化前列腺癌 (PCa) 多参数MRI (mpMRI) 解释.
- 尽管有更新,但PI-RADS评分的现实世界变化仍然存在,可能会限制临床益处和标准化.
研究的目的:
- 评估社区实践与高等学术中心之间PCa mpMRIPI-RADS评分的差异.
- 评估这些差异对诊断准确性和读者间可靠性的影响.
主要方法:
- 来自非学术机构的262个mpMRI研究的回顾性分析,由学术放射学家重新解释.
- 在社区和学术解释之间对临床显著PCa (csPCa) 的PI-RADS得分和诊断准确度的比较.
- 使用类内相关性 (ICC) 和kappa统计数据评估读者间可靠性;通过ROC分析评估诊断准确性.
主要成果:
- 一般来说,PI-RADS评分的读者间一致性和可靠性很差 (ICC=0.393-0.407,kappa=0.336).
- 社区读者解释的PI-RADS 3病变没有观察到任何协议.
- 诊断准确性在队列之间是相似的 (ROC AUC:0.759对比0.785),PI-RADS 3作为csPCa检测的最佳切线.
结论:
- 对csPCa的mpMRI诊断准确性在学术和社区环境之间是可比的.
- 在这些设置之间存在mpMRI解释的显著变化,风险在PCa管理中的实践变化.
- 不一致的PI-RADS评分,特别是PI-RADS 3病变,可能导致低于最佳的活检建议,可能导致遗漏的csPCa或不必要的程序.
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