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目的评价应用表面线圈1.5TMRI检测局部进展期前列腺癌的准确性及其临床意义。方法选取2007年12月—2010年1月间共209例进展期前列腺癌病人(平均年龄为62.5岁)作为研究对象,他们均接受了机器辅助腹腔镜前列腺切除术及术前MRI检查进行肿瘤分期,其中135例(64.6%)病人为局部进展期前列腺癌病人。将传统的临床肿瘤分期和MRI检查评估肿瘤分期与组织病理学肿瘤分期(PT)进行比较。以组织病理学肿瘤分期(PT)作为“金标准”计算临床肿瘤分期和MRI检查评估肿瘤分期的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)和总准确度(OA)。MRI检查肿瘤分期高估和低估的病例都要进行回顾分析。结果传统临床肿瘤分期前列腺局部进展期病灶检测的敏感度、特异度、阳性预测值、阴性预测值和总准确度分别为25.9%、95.9%、92.1%、41.2%和50.5%,而MRI检查评估肿瘤分期前列腺局部进展期病灶检测的敏感度、特异度、阳性预测值、阴性预测值和总准确度分别为56.3%、82.2%、85.4%、50.4%和65.4%。MRI检查肿瘤分期低估的病人,64.4%的病例(38/59)的手术切缘是阴性的。结论虽然目前对前列腺肿瘤检测的准确性有局限性,但当MRI检查加入到常规的临床分期评估中时,局部进展期病灶的检出有了明显的提高。然而,大部分肿瘤分期被低估的病人手术切缘是阴性的。在评估MRI检查肿瘤分期的临床意义时,必须考虑前列腺外病灶侵犯范围。要点①MRI大大提高了局部晚期前列腺癌的发现率。②MRI在总的分期准确度方面有限。③大多数在MRI上未被确认的T3期癌症的手术切缘是阴性的。④评价MRI的真正临床意义仍有一定难度。
Objective To evaluate the accuracy and clinical significance of using surface coil 1.5TMRI in the detection of locally advanced prostate cancer. METHODS: A total of 209 patients with advanced prostate cancer (mean age, 62.5 years) from December 2007 to January 2010 were enrolled in this study. All of them underwent machine-assisted laparoscopic prostatectomy and preoperative MRI for tumor staging Among them, 135 patients (64.6%) were patients with locally advanced prostate cancer. Traditional clinical tumor staging and MRI examinations were compared for tumor staging with histopathological tumor staging (PT). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of the tumor staging and MRI examination were calculated using histopathological tumor staging (PT) as the “gold standard” (OA). MRI examination of tumor staging overvalued and underestimated cases should be reviewed. Results The sensitivity, specificity, positive predictive value, negative predictive value and total accuracy of the detection of locally advanced lesions in the staged clinical staging were 25.9%, 95.9%, 92.1%, 41.2% and 50.5%, respectively. However, MRI examination and assessment The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the locally advanced prostate cancer staging were 56.3%, 82.2%, 85.4%, 50.4% and 65.4%, respectively. In patients with an underestimated tumor stage by MRI, surgical margins were negative in 64.4% of the cases (38/59). Conclusions Although the accuracy of prostate tumor detection is limited at present, the detection of locally advanced lesions has been significantly improved when MRI is added to routine clinical staging. However, the surgical margins of most patients with underestimated tumor staging are negative. In assessing the clinical significance of MRI in staging of tumors, the extent of extra-prostatic lesions must be considered. Points ①MRI greatly increased the detection rate of locally advanced prostate cancer. ② MRI is limited in terms of total staging accuracy. ③ Most of the unresected T3 cancers at MRI were surgical negative. ④ Evaluation of the true clinical significance of MRI is still a certain degree of difficulty.