O estudo da acurácia da ressonância magnética multiparamétrica no diagnóstico do câncer de próstata

• Ano de defesa: 2017
• Autor(a) principal: Moraes, Márcia Cristina Gonçalves de Oliveira
• Orientador(a): Baldisserotto, Matteo
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul
• Programa de Pós-Graduação: Programa de Pós-Graduação em Medicina e Ciências da Saúde
• Departamento: Escola de Medicina
• País: Brasil
• Palavras-chave em Português: Câncer de Próstata; RMmp (Ressonância Magnética multiparamétrica); PI-RADS v2 (“Prostate Imaging Reporting and Data System” Versão 2); ADC (“Apparent Diffusion Coefficient” = Coeficiente de Difusão Aparente)
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::MEDICINA
• Link de acesso: http://tede2.pucrs.br/tede2/handle/tede/8227

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.