Sacit Nuri GÖRGEL, Şebnem KARASU, Mehmet COŞKUN, Engin ULUÇ, Merve HOROZ DÖNMEZ, İrfan ÖCAL

KLİNİK ANLAMLI PROSTAT KANSERİ TESPİTİNDE PI-RADSv2 SKORU SINIR DEĞERİNİN TESPİTİ

Giriş: Prostat kanseri erkeklerin 2. En sık kanseridir. Prostat manyetik rezonans görüntüleme, klinik anlamlı prostat kanseri (KAK) tespitinde umut vaad etmekdir. Bu çalışmada, KAK tanısında prostat görüntüleme raporlandırma vebilgi sistemi 2. versiyon (PI-RADSv2) skoru sınır değerinin tespiti amaçlanmıştır.Gereç ve Yöntem: Bu bir retrospektif çalışma olupHaziran 2018 ile Mart 2019 tarihleri arasında, multiparametrikprostat manyetik rezonans görüntüleme ve 12 kadran sistemik prostat biyopsisi yapılan 133 olguyukapsamaktadır. Lezyonlar, PI-RADSv2 rehberine göre, iki radyolog tarafından consensus ile sınıflandı.PI-RADS skoru sınır değeri skor ≥ 3, ≥ 3+1 ve ≥ 4 olacak şekild eayrı ayrı ele alındı. Bu sınır değerler için,Gleason ≥ 3+4 tümör tanısında, alıcı çalışma karakteristik eğrisi (ROC) kullanılarak, duyarlılık, özgüllük, pozitif venegatif öngörü değeri ve eğrinin altında kalan alan (EAA) hesaplandı. EAA değerleri Delong testi ile karşılaştırıldı.Bulgular: PI-RADSv2 kategori 1-3, 3+1 ve 4-5 vaka sayıları, sırasıyla 49, 10 ve 74’tü. PI-RADS skoru ≤ 2olanlarda yalnızca 1 KAK (Gleason ≥ 3+4) görüldü.KAK tespitinde duyarlılık, özgüllük, pozitif ve negative öngörü değeri sırasıyla, skor ≥ 3 için 98.3%, 50.7%, 62.1%,97.4%, skor ≥ 3+1 için 88.3%, 71.2%, 71.6%,88.1% veskor ≥ 4 için 88.3%, 71.2%, 71.6%, 88.1% bulundu. EAA,skor ≥ 3 için 0.745, skor ≥ 3+1 için 0.760 veskor ≥ 4 için 0.798’di. Skor ≥ 3, ≥ 3+1 ve ≥ 4 arasında EAA’laraçısından anlamlı fark yoktu.Sonuç: Dinamik kontrastlı incelemede pozitiflik biyopsi yönetimini değiştirmemektedir. Skor ≥ 3 lezyonlarörneklenmelidir.

DETERMINATION OF OPTIMAL CUT-OFF PI-RADSv2 SCORE IN CLINICALLYSIGNIFICANT PROSTATE CANCER DETECTION

Introduction: Prostate cancer is the second leading cancer of men. Prostate magnetic resonance imaging is promising in detection of clinically significant prostate cancer (CSca). In this study, it was aimed to determine the cut-off Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) score in diagnosis of CSca. Material and Method: This retrospective study included 133 patients who underwent multiparametric prostate magnetic resonance imaging (mpMRI) and 12 quadrant systematic prostate biopsy and/or radical prostatectomy between January 2018 and March 2019. Lesions were categorized using the PI-RADSv2 guideline by two radiologists with consensus. The cut-off PI-RADSv2 scores were evaluated separately as score ≥ 3, score ≥ 3+1, and score ≥ 4. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated for each cut-off in the diagnosis of Gleason ≥ 3+4 using receiver operating characteristic (ROC). AUCs were compared with Delong test. Results: The numbers of patients in PI-RADSv2 category 1-3, 3+1, and 4-5 were 49, 10, and 74, respectively. There was only one CSca (Gleason ≥ 3+4) with PI-RADS scored ≤ 2. In detection of CSca, sensitivity, specificity, PPV, and NPV were 98.3%, 50.7%, 62.1%, and 97.4% in score ≥ 3, 91.7%, 60.3%, 65.5%, and 89.8% in score ≥ 3+1 and, 88.3%, 71.2%, 71.6%, and 88.1% in score ≥ 4, respectively. The AUCs were 0.745 in score ≥ 3, 0.760 in score ≥ 3+1, and 0.798 in score ≥ 4. There was no statistical difference between AUCs of ≥ 3, ≥ 3+1, and ≥ 4. Conclusion: Positivity in dynamic contrast enhancement may not change the management of biopsy. The lesions with scored ≥ 3 should be sampled.

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