The role of apparent diffusion coefficient values in diagnosing prostate cancer for patients with equivocal PI-RADS 3 lesions: a multicenter retrospective study

作者：Changming Wang, Qifei Dong, Lei Yuan, Zheng Zhang, Shengjun Xu, Yukui Gao, Yuanyuan Guo, Mengjie Chen, Sheng Wang, Zhuo Dong, Jun Xiao · 发表于：International Journal of Surgery · 年份：2025 · DOI：10.1097/js9.0000000000003269 · 被引用次数：5 · 研究领域：Prostate Cancer Diagnosis and Treatment、MRI in cancer diagnosis、Prostate Cancer Treatment and Research

PURPOSE: To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) values for the detection of clinically significant prostate cancer (csPCa) in patients with equivocal Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions. MATERIALS AND METHODS: In this multicenter retrospective study, data from 460 eligible patients meeting predefined inclusion criteria were analyzed. Following the establishment of a standardized region of interest delineation protocol, ADC measurements were obtained for all PI-RADS 3 lesions. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curves with calculation of the area under the curve (AUC). The multivariate model's discriminative ability was assessed through ROC analysis, while calibration was evaluated using calibration plots. Clinical utility was quantified via decision curve analysis. A risk stratification system was subsequently developed to optimize clinical decision-making. RESULTS: For the 460 patients with PI-RADS 3 lesions, 108 (23.5%) were diagnosed with any grade prostate cancer, and 62 (13.5%) were diagnosed with csPCa. The results of the multivariate analysis indicated that prostate volume (OR = 0.957, 95% CI: 0.931-0.984, P = 0.002), minimum ADC (ADCmin) (OR = 0.009, 95% CI: <0.001-0.381, P = 0.014), and lesions in the peripheral zone (OR = 6.269, 95% CI: 2.332-16.8...