Peripheral zone volume ratio (PZ-ratio) is relevant with biopsy results and can increase the accuracy of current diagnostic modality
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Yifan Chang1,*, Rui Chen1,*, Qingsong Yang2,*, Xu Gao1, Chuanliang Xu1, Jianping Lu2, Yinghao Sun1
1Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
2Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*These authors contributed equally to this work
Yinghao Sun, email: firstname.lastname@example.org
Jianping Lu, email: email@example.com
Keywords: biopsy, diagnosis, multiparametric MRI, peripheral zone volume ratio, prostate cancer
Received: June 13, 2016 Accepted: March 21, 2017 Published: March 31, 2017
The current diagnostic modality of prostate cancer based on prostate specific antigen (PSA) and systematic biopsy is far from ideal in terms of over-diagnosing indolent prostate cancer and missing significant ones. Thus we integrated the peripheral zone volume ratio (PZ-ratio) for diagnostic refinement. This retrospective study included 247 consecutive patients who underwent initial transrectal ultrasound-guided systematic prostate biopsy from April 2014 to November 2015. Prostate volume was determined by semi-automatic contour on axial T2 weighted magnetic resonance imaging (MRI). PZ-ratio was inversely correlated with age (r = −0.36, p <0.0001). Adding PZ-ratio and MRI findings to the current predictive model (age, PSA density, percent-free PSA) significantly increased diagnostic accuracy in all patients (AUC: 0.871 vs. 0.812, p = 0.0059), but not in patient subgroup with PSA 4–10 ng/ml (AUC: 0.863 vs. 0.803, p = 0.12). The new model also significantly reduced the number of unnecessary biopsies while missing less significant cancers at a probability threshold of 25%. PZ-ratio is a potential tool in predicting biopsy results, and when added alone or in combination with MRI findings, the diagnostic accuracy can be further enhanced.
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