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PI-RADS 3 核磁共振损伤:活检还是需要的吗?
Thibaut Long Depaquit1, Alessandro Uleri2, Arthur Peyrottes3
1Department of Urology, HIA Sainte-Anne, Toulon, France; Department of Urology, North Hospital, AP-HM, Marseille, France.
针对PI-RADS 3病变的向性前列腺活检可以检测出临床显著的前列腺癌 (csPCa),同时减少过度诊断. 临床因素如T阶段和病变大小有助于预测csPCa的存在.
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:
- 许多新诊断的前列腺癌 (PCa) 病例增长缓慢,风险低.
- 对PI-RADS 3病变的最佳活检策略需要进一步调查.
- 这项研究评估了PI-RADS 3病变中csPCa的诊断产量和预测因素.
研究的目的:
- 评估目前PI-RADS 3病变的活检方案的诊断价值.
- 确定临床预测因子,以提高临床显著PCa (csPCa) 的检测.
- 在不同的活检策略中比较csPCa检测率.
主要方法:
- 来自两所学术中心 (2017-2024) 的163名PI-RADS 3病变患者的回顾性分析.
- 前列腺活检通过穿直肠或跨关节路线进行,包括系统和MRI向的核心 (融合或认知).
- 被归类为良性,不显著的PCa (insignPCa,ISUP 1) 或csPCa (ISUP≥2) 的患者.
主要成果:
- 在163个病变中,55.8%是良性的,32%是不良的PCa,12.3%是 csPCa.
- 仅针对性活检就错过了4.9%的csPCa,但避免了24.5%的标记PCa.
- 目标+ipsilateral系统核心错过了3.8%的csPCa,避免了12.9%的insignPCa;在csPCa检测与黄金标准之间没有显著差异.
- 年龄,临床T阶段和mpMRI损伤大小预测了csPCa.
结论:
- 对PI-RADS 3病变的活检的诊断价值是有争议的,因为csPCa的比例很低.
- 使用ipsilateral系统核的向活检可以改善csPCa的检测并减少过度诊断.
- 临床T阶段和MRI病变大小是csPCa的潜在预测因素.
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