Natural history of small index lesions suspicious for prostate cancer on multiparametric MRI: recommendations for interval imaging follow-up

作者：Rais Bahrami Soroush^*; Tuerkbey Baris; Rastinehad Ardeshir R; Walton Diaz Annerleim; Hoang Anthony N; Siddiqui M Minhaj; Stamatakis Lambros; Truong Hong; Nix Jeffrey W; Vourganti Srinivas; Grant Kinzya B; Merino Maria J; Wood Bradford J; Choyke Peter L; Pinto Peter A

来源：Diagnostic and Interventional Radiology, 2014, 20(4): 293-298.

DOI：10.5152/dir.2014.13319

PURPOSE We aimed to determine the natural history of small index lesions identified on multiparametric-magnetic resonance imaging (MP-MRI) of the prostate by evaluating lesion-specific pathology and growth on serial MP-MRI.
MATERIALS AND METHODS We performed a retrospective review of 153 patients who underwent a minimum of two MP-MRI sessions, on an institutional review board-approved protocol. Index lesion is defined as the lesion(s) with the highest cancer suspicion score based on initial MP-MRI of a patient, irrespective of size. Two study cohorts were identified: (1) patients with no index lesion or index lesion(s) <= 7 mm and (2) a subset with no index lesion or index lesion(s) <= 5 mm. Pathological analysis of the index lesions was performed following magnetic resonance/ultrasound fusion-guided biopsy. Growth rate of the lesions was calculated based on MP-MRI follow-up.
RESULTS Patients with small index lesions measuring <= 7 mm (n=42) or a subset with lesions <= 5 mm (n=20) demonstrated either benign findings (86.2% and 87.5%, respectively) or low grade Gleason 6 prostate cancer (13.8% and 12.5%, respectively) on lesion-specific targeted biopsies. These lesions demonstrated no significant change in size (P = 0.93 and P = 0.36) over a mean imaging period of 2.31 +/- 1.56 years and 2.40 +/- 1.77 years for <= 7 mm and <= 5 mm index lesion thresholds, respectively. These findings held true on subset analyses of patients who had a minimum of two-year interval follow-up with MP-MRI.
CONCLUSION Small index lesions of the prostate are pathologically benign lesions or occasionally low-grade cancers. Slow growth rate of these small index lesions on serial MP-MRI suggests a surveillance interval of at least two years without significant change.

• 出版日期2014-7
• 单位NIH