Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Detection of Incidental Prostate Cancer or Urothelial Carcinoma Extension in Urinary Bladder Cancer Patients by Using Multiparametric MRI: A Retrospective Study Using Prostate Imaging Reporting and Data System Version 2.0

방광암 환자의 다중 매개 자기공명영상에서 우연히 발견된 전립선암 또는 요로상피세포암종의 전립선 침범의 검출: 전립선 이미징 보고 및 데이터 시스템 버전 2.0을 사용한 후향적 연구

  • Sang Eun Yoon (Department of Radiology, Ewha Womans University Mokdong Hospital) ;
  • Byung Chul Kang (Department of Radiology, Ewha Womans University Mokdong Hospital) ;
  • Hyun-Hae Cho (Department of Radiology, Ewha Womans University Mokdong Hospital) ;
  • Sanghui Park (Department of Pathology, Ewha Womans University College of Medicine)
  • 윤상은 (이화여자대학교 목동병원 영상의학과) ;
  • 강병철 (이화여자대학교 목동병원 영상의학과) ;
  • 조현혜 (이화여자대학교 목동병원 영상의학과) ;
  • 박상희 (이화여자대학교 의과대학 병리학교실)
  • Received : 2019.06.08
  • Accepted : 2019.09.27
  • Published : 2020.05.01
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Abstract

Purpose The study aimed to investigate the role of Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) in predicting incidental prostate cancer (PCa) or urothelial carcinoma (UCa) extension in urinary bladder (UB) cancer patients. Materials and Methods A total of 72 UB cancer patients who underwent radical cystoprostatectomy and 3 Tesla multiparametric MRI before surgery were enrolled. PI-RADS v2 ratings were assigned by two independent radiologists. All prostate specimens were examined by a single pathologist. We compared the multiparametric MRI findings rated using PI-RADS v2 with the pathologic data. Results Of the 72 UB cancer patients, 29 had incidental PCa (40.3%) and 20 showed UCa extension (27.8%), with an overlap for 3 patients. With a score of 4 as the cut-off value for predicting incidental PCa, the diagnostic accuracy was 65.3%, specificity was 90.7%, and positive predictive value (PPV) was 66.7%. The diagnostic accuracy for incidental UCa extension was 47.2%, specificity was 92.3%, and PPV was 83.3%. Conclusion Despite the low diagnostic accuracy, the PPV and specificity were relatively high. Therefore, PI-RADS v2 scores of 1, 2, or 3 may help exclude the probability of incidental PCa or UCa extension.

목적 본 연구는 방광암 환자에서 전립선 Prostate Imaging Reporting and Data System version 2 (이하 PI-RADS v2)가, 우연히 발견된 전립선암 또는 요로상피세포암종의 전립선침범을 예측하는데 도움이 되는지 분석하였다. 대상과 방법 3 Tesla 다중 매개 자기공명영상에서 수술 전 영상을 촬영한 후, 근치적 방광전립 선절제술을 시행한 72명의 방광암 환자가 연구에 포함되었다. 수술 전 영상 소견은 두 명의 영상의학과 의사가 분석하였고, 수술 검체는 한 명의 병리과 의사가 평가하였다. 그 후, 전립선 PI-RADS v2의 결과와 병리 소견을 비교 분석하였다. 결과 72명의 방광암 환자 중 29명이 전립선암(40.3%)이 있었고, 20명이 요로상피세포암종(27.8%)이 있었다. 스코어 4를 기준값으로 설정하였을 때, 전립선암을 예측하는 진단 정확도는 65.3%, 특이도는 90.7%, 양성 예측도는 66.7%였다. 또한 전립선암 또는 요로상피세포암종을 예측하는 진단 정확도는 47.2%, 특이도는 92.3%, 양성 예측도는 83.3%였다. 결론 정확도는 낮은 편이었지만, 양성 예측도와 특이도는 높은 편이었다. 따라서 전립선 PI-RADS v2에서 스코어 1, 2 또는 3에 해당되면 우연히 발견된 전립선암과 요로상피세포암종의 침범을 배제하는데 도움이 될 수 있다.

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