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开发和验证风险分层活检决策途径,包括MRI和PSA衍生指标
Pengfei Jin1, Ximing Wang2, Zhenwei Ding3
1Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
使用MRI,前列腺特异性抗原密度 (PSAD) 和免于总PSA (f/tPSA) 的风险适应途径的开发可以改善临床显著的前列腺癌 (csPCa) 检测,同时减少不必要的活检.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 放射学 放射学是一门学科.
- 在瘤学瘤学.
背景情况:
- 前列腺癌的诊断依赖于准确的风险分层,以平衡临床重要疾病的检测,避免不必要的程序.
- 磁共振成像 (MRI) 和前列腺特异性抗原 (PSA) 标记物,如PSA密度 (PSAD) 和自由至总PSA比率 (f/tPSA) 是此评估中的关键工具.
研究的目的:
- 开发和评估风险适应的条件活检途径,整合MRI,PSAD和f/tPSA,以加强临床显著前列腺癌 (csPCa) 的检测.
- 降低低风险概况的患者"负面"活检率.
主要方法:
- 追溯分析了1018名患者的数据,包括PI-RADS类别,PSAD,f/tPSA和活检病理学.
- 构建风险分层矩阵表,将MRI发现与PSA衍生指标相结合.
- 建立六种活检决策途径 (三种临床,三种MRI结合) 并评估csPCa检测,活检避免和负活检率.
- 使用决策曲线分析 (DCA) 评估路径净收益.
主要成果:
- 与临床途径 (85%-91%) 相比,MRI组合途径显示了较高的csPCa检测率 (94%-96%).
- "MRI + PSAD + f/tPSA"途径实现了94%的csPCa检测率,40%的活检避免率和25%的负活检率.
- 决策曲线分析证实,MRI联合途径的净收益显著更高.
结论:
- 将MRI与PSA衍生指标 (PSAD, f/tPSA) 整合在一起,为前列腺癌管理提供了有效的风险分层.
- 这些综合途径提高了csPCa的检测,并大大减少了不必要的"负"活检,改善了患者的治疗结果.
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