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Previous issue date: 2017-08-30 / Abstract: Today, the incidence of prostate cancer is considered high, however, unlike other malignant tumours, there is an expressive number of cases in which prostate cancer does not progress to clinical disease. The management of patients with prostate cancer should be individually fitted due to the broad behaviour spectrum of this cancer, ranging from low grade tumours with low aggressive biological characteristics to high grade tumours with metastatic capacity. The possibility of predicting the future behavior of the disease allows the selection of the most appropriate conduct for each case. Studies have shown that mpMRI (multiparametric Magnetic Resonance Imaging) has a high negative predictive value for clinically significant prostate cancer, indicating that its application as a screening method and as assessment method of disease progression is promising. To standardize the protocols and reports of prostate mpMRI, the PI-RADS v2 (Prostate Imaging Reporting and Data System version 2) was launched in 2015. Multiparametric Magnetic Resonance Imaging standardized by PI-RADSv2 has been taking a prominent place in the management of prostate cancer, but the specificity and positive predictive value still need to be improved. Purpose: To assess whether the ADC (Apparent diffusion coefficient) value and tumour ADC ratio associated with PI-RADS v2 may increase accuracy in predicting clinically significant prostate cancer. Materials and methods: 91 individuals with suspected prostate cancer were retrospectively studied through mpMRI imaging standardized by PI-RADS v2, obtaining the ADC value from the tumour and the contralateral tissue. The findings were correlated to anatomopathological study (biopsy, prostatectomy or transurethral resection). Results: Accuracy, sensitivity, specificity, positive predictive value and negative predictive value for the consensus between the two reviewers using PI-RADS v2, category 3 associated with categories 4 and 5 for the detection of clinically significant cancer were 70.3%, 97.4%, 50.9%, 58.7% and 96.4% (p <0.001), respectively. The association of the ADC value (<0.795x10-3) to categories 3, 4 and 5 of the PI-RADSv2, in turn, demonstrated accuracy, specificity and positive predictive value of 78.9%, 84.9% and 76.5%; and the association with the tumour ADC ratio (<0.62) presented 77.5%, 86.5% and 77.4% of accuracy, specificity and positive predictive value, respectively. Conclusion: The association of the ADC value and the tumour ADC ratio to the PI-RADS v2 in mpMRI increases the accuracy, specificity and positive predictive value in the detection of aggressive prostate cancer, and may help in the screening of individuals who would undergo invasive procedures and radical therapy, or conservative management, as active surveillance or watchful waiting. / Introdu??o: ? considerada alta a incid?ncia de c?ncer de pr?stata na atualidade, contudo, diferentemente de outras neoplasias, existe um n?mero expressivo de casos em que o c?ncer de pr?stata n?o evolui para a doen?a cl?nica. Por este motivo, o manejo dos pacientes com neoplasia prost?tica deve ser moldado individualmente face ao amplo espectro que varia desde tumores de baixo grau, com caracter?sticas biol?gicas de baixa agressividade, a tumores de alto grau, com capacidade metast?tica. A possibilidade de prever o comportamento futuro da doen?a permite a sele??o da conduta mais adequada para cada caso. Estudos vem comprovando que a Resson?ncia Magn?tica multiparam?trica (RMmp) apresenta um alto valor preditivo negativo para o c?ncer de pr?stata com signific?ncia cl?nica, indicando que sua aplica??o como m?todo de triagem e na avalia??o da progress?o da doen?a ? promissora. Para padronizar os protocolos e os relat?rios da RMmp da pr?stata foi lan?ado em 2015 o PI-RADS v2 (?Prostate Imaging Reporting and Data System? vers?o 2). A RMmp padronizada pelo PI-RADS v2 vem assumindo um lugar de destaque no manejo do c?ncer de pr?stata, contudo, ainda s?o considerados baixos a Especificidade e o Valor Preditivo Positivo. Objetivos: Avaliar se o valor de ADC (?Apparent diffusion coefficient? = Coeficiente de Difus?o Aparente) e a raz?o tumoral do ADC associados ao PI-RADS v2 podem aumentar a acur?cia da RMmp na predi??o do c?ncer de pr?stata com signific?ncia clinica. Materiais e m?todos: Foram estudados retrospectivamente 91 indiv?duos com suspeita de c?ncer de pr?stata, submetidos a RMmp padronizada pelo PI-RADS v2, obtendo-se o ADC quantitativo da les?o e do tecido contralateral. Os achados foram correlacionados ao estudo anatomopatol?gico (bi?psia, prostatectomia ou ressec??o transuretral). Resultados: A acur?cia, sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para o consenso entre os dois avaliadores utilizando a RMmp padronizada pelo PI-RADS v2, com a categoria 3 associada as categorias 4 e 5 para a detec??o do c?ncer com signific?ncia cl?nica foram 70,3%; 97,4%; 50,9%; 58,7% e 96,4% (p<0,001), respectivamente. A associa??o do valor do ADC (<0,795x10-3) ?s categorias 3, 4 e 5 do PI-RADS v2, por sua vez, demonstrou acur?cia, especificidade e valor preditivo positivo de 78,9%; 84,9% e 76,5%; e a associa??o com a raz?o tumoral do ADC (< 0,62), apresentou 77,5%; 86,5% e 77,4% de acur?cia, especificidade e valor preditivo positivo, respectivamente. Conclus?o: A associa??o do valor do ADC e da raz?o tumoral do ADC ao PI-RADS v2 na RMmp aumenta a acur?cia, especificidade e valor preditivo positivo na detec??o do c?ncer agressivo da pr?stata, podendo auxiliar na triagem dos indiv?duos e na decis?o entre
a conduta agressiva, com procedimentos invasivos e terapia radical, ou a conduta conservadora, com vigil?ncia ativa ou observa??o.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/8227 |
| Date | 30 August 2017 |
| Creators | Moraes, M?rcia Cristina Gon?alves de Oliveira |
| Contributors | Baldisserotto, Matteo |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, Brasil, Escola de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 500, 500, 500, -224747486637135387, -969369452308786627 |
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