The value of the prostate imaging reporting and data system version 2 for the diagnosis of prostate cancer / 中华泌尿外科杂志

ABSTRACT

Objective To evaluate the value of the prostate imaging reporting and data system version 2 (PI-RADS version 2) for the diagnosis of prostate cancer.Methods A total of 243 patients who underwent multiparametric 3T prostate MRI followed by prostate biopsy or radical prostatectomy were included.111 patients were in PSA gray zone(4.0-10.0 ng/ml).PI-RADS version 2 scores for each patient was assigned by two readers independently.Reference standard was obtained by histopathology.Positive predictive value (PPV) for prostate cancer and clinically significant cancer were compared among patients with different PI-RADS Version 2 scores using chi-square trend test.Receiver operating characteristic (ROC) curve was performed to assess diagnostic accuracy of the PI-RADS version 2 scores for prostate cancer detection,and evaluate the difference in diagnostic efficiency between transition zone and peripheral zone.Results Two hundred and eighty five suspicious foci from the 243 patients were finally recruited to this study,131 of which were diagnosed as prostate cancer according to pathology.There was significant difference in PPV for prostate cancer and clinically significant cancer among patients with different PI-RADS version 2 scores (score 18.0％;score 210.1％;score 349.2％;score 461.1％ score 587.9％,P＜0.01),(score 10;score 25.1％;score 331.1％;score 459.3％ score 588.9％,P ＜ 0.01).When PI-RADS version 2 score was 3,Youden index was maximum (0.53),the sensitivity was 92.4％ and the specificity was 61.0％.The ROC analysis revealed that the area under the curve (AUC) of prostate cancer incidence in transition zone was similar to that in peripheral zone with 0.86(95％ CI 0.78-0.95) vs.0.83(95％ CI 0.77-0.89).There were 111 patients in PSA gray zone,33 of whom were diagnosed as prostate cancer.If we used PI-RADS version 2 score 3 as the cut-off point,47 out of 111 patients would avoid unnecessary prostate biopsies with 4 misdiagnosed nonsignificant prostate cancer.Conclusions The value of PI-RADS version 2 score is positively associated with PPV for prostate cancer.PI-RADS version 2 seems to have good diagnostic accuracy in prostate cancer detection.Clinical application of PI-RADS version 2 may help to reduce the number of unnecessary biopsy.