在积极监视的男性中,MR可见性/不可见性的预测值
Laurence Klotz1, Andrew Loblaw2, Liying Zhang3
1Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. laurence.klotz@sunnybrook.ca.
Prostate cancer and prostatic diseases
|January 17, 2025
概括
积极监测前列腺癌 (AS) 的男性的负核磁共振扫描表明疾病进展或需要治疗的风险非常低. 这表明,MRI指导的管理可以有效地识别临床上显著的癌症,而不需要例行活检.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 在瘤学瘤学.
- 放射学 放射学是指放射学
背景情况:
- 主动监测 (AS) 是低风险前列腺癌的管理策略.
- 磁共振成像 (MRI) 越来越多地用于AS协议.
- 在AS中负MRI发现的预后价值需要进一步澄清.
研究的目的:
- 为了评估阴性MRI结果的预后意义,在接受AS的男性中.
- 评估与MRI发现有关的活检升级和干预率.
- 为了确定MRI指导的管理是否可以取代AS的常规活检.
主要方法:
- 对AS男性进行前性,单中心研究,定期进行MRI.
- 主要结局:活检升级和干预率.
- 阴性MRI患者仅在指示时进行系统活检;其他人则进行了向活检.
主要成果:
- 在530名患者中,7.4%的MRI呈阴性. 没有任何阴性MRI (PiRADS 1-2) 的患者被升级或需要干预.
- 阳性MRI (PiRADS 3-5) 患者的升级和治疗率显著更高 (p < 0.001).
- 核磁共振成像进展与升级增加相关;稳定/改善核磁共振成像显示升级率较低.
结论:
- 在MRI看不见的癌症中,进展很小,不需要干预.
- 在AS患者中,负MRI与没有进展至格里森等级≥3或转移性疾病有关.
- 用有针对性的活检进行图像引导的管理可能足以识别AS中的重大癌症,从而减少对常规活检的需求.
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