在mpMRI和PSMA PET/CT时代:数字直肠检查是否仍然重要?
Anil Eker1, Fatih Diler2, Selda Yilmaz Tatar3
1Department of Urology, Izmir City Hospital, Izmir, Turkey.
数字直肠检查 (DRE) 对于识别高风险前列腺癌 (PCa) 仍然很有价值. 当与多参数MRI (mpMRI) 和PSMA PET/CT相结合时,DRE有助于风险分层.
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:
- 传统前列腺癌 (PCa) 诊断工具数字直肠检查 (DRE) 越来越多地被多参数核磁共振 (mpMRI) 和68Ga-PSMA PET/CT等先进成像技术所取代.
- 在PCa诊断和分期的现代成像时代,DRE的临床实用性是不确定的.
- 这项研究重新评估了DRE的诊断价值与当代成像方式相结合.
研究的目的:
- 评估DRE在前列腺癌 (PCa) 检测和分期的诊断性能.
- 确定DRE发现与mpMRI和PSMA PET/CT结果之间的相关性.
- 评估DRE在PCa管理中作为高级成像技术的辅助工具的作用.
主要方法:
- 对164名前列腺腺癌患者的回顾性分析,这些患者接受了经直肠超声波引导的活检.
- 在活检之前进行了DRE;151名患者进行了mpMRI (PI-RADS v2.1评分),62名患者进行了PSMA PET/CT (记录SUVmax).
- 多变量统计和ROC分析检查了DRE,成像,活检和病态分期 (156名患者的激进前列腺切除术后) 之间的关系.
主要成果:
- 怀疑的DRE发现 (n=64) 与较高的PI-RADS得分,较大的病变大小,较高的SUVmax和临床显著的PCa (p < 0.001) 有关.
- 每个PI-RADS得分的增加都与DRE阳性概率的两倍增加相关;ROC分析确定了DRE阳性的值 (损伤大小13.5毫米,SUVmax15.1).
- 怀疑的DRE与晚期病理阶段 (≥pT3) (p <0.001) 强烈相关.
结论:
- 数字直肠检查 (DRE) 仍然是识别高风险和晚期前列腺癌 (PCa) 的一个有价值的辅助.
- 将DRE发现与mpMRI和PSMA PET/CT整合在一起,为风险分层提供了关键的额外临床洞察力.
- 在现代前列腺癌诊断工作流程中,DRE继续发挥着重要作用,特别是在风险评估而不是初始查方面.
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