前列腺局灶消融后PI-FAB评分在不可逆电穿孔治疗中的诊断准确性及读者间一致性
本研究评估PI-FAB评分系统在不可逆电穿孔（IRE）治疗后检测临床显著前列腺癌（csPCa）复发的诊断准确性及读者间一致性。单中心回顾性纳入44例患者，两位放射科医生独立评分，读者间一致性为实质性（加权kappa 0.680），敏感度71.4%，特异度81.1%-89.2%，阴性预测值超过93%。结论认为PI-FAB具有良好特异度和高阴性预测值，低评分患者可继续监测而非立即活检。
要点
- PI-FAB评分用于IRE术后监测，读者间一致性为实质性（加权kappa 0.680）。
- 检测csPCa复发的敏感度为71.4%，特异度为81.1%-89.2%，阴性预测值超过93%。
- 低PI-FAB评分患者可考虑继续监测，避免不必要的立即活检。
英文原文（摘要）· 点击展开
BACKGROUND: Detecting recurrence after focal therapy for prostate cancer is challenging due to treatment-induced MRI changes and unreliable PSA kinetics. The Prostate Imaging after Focal Ablation (PI-FAB) scoring system was developed to standardize post-treatment MRI interpretation, yet validation in irreversible electroporation (IRE) populations is lacking. We evaluated PI-FAB diagnostic accuracy for detecting clinically significant prostate cancer (csPCa) recurrence after IRE and assessed inter-reader agreement.
METHODS: This single-institution retrospective study included consecutive patients undergoing primary IRE for localized prostate cancer with post-IRE multiparametric MRI and confirmatory biopsy at minimum one-year follow-up. Two radiologists independently assigned PI-FAB scores (1-3) while blinded to pathology. The reference standard was confirmatory biopsy (csPCa defined as ISUP Grade Group ≥ 2). Inter-reader agreement was assessed using percent agreement, unweighted and weighted Cohen's kappa, Gwet's AC1, and Gwet's AC2.
RESULTS: Of 71 screened patients, 44 met inclusion criteria. Seven (15.9%) had in-field csPCa recurrence. Both readers achieved sensitivity of 71.4% (95% CI: 29.0-96.3%), with specificity of 89.2% and 81.1%, respectively. Negative predictive value exceeded 93% for both readers. Inter-reader agreement was substantial (percent agreement: 81.8%; weighted kappa: 0.680; Gwet's AC1: 0.770; Gwet's AC2: 0.805). Limitations include small sample size, wide confidence intervals, and single-institution design.
CONCLUSION: PI-FAB demonstrated good specificity, high negative predictive value, and substantial inter-reader agreement for post-IRE surveillance. Patients with low PI-FAB scores may be managed with continued monitoring rather than immediate biopsy. Larger multicenter studies are needed before routine clinical implementation.
引用
- Altan SA, Sakar R, Onay A, et al. Prostate imaging after focal ablation scoring after irreversible electroporation treatment in localized prostate cancer: Diagnostic accuracy and inter-reader agreement. Eur J Radiol. 2026. PMID: 42172740. doi:10.1016/j.ejrad.2026.112948
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。