PURPOSE We investigated the association of MRI findings in men with a previous diagnosis of atypical small acinar proliferation (ASAP) or multifocal high-grade intraepithelial neoplasia (HGPIN) with pathologic findings on repeat biopsy. MATERIALS AND METHODS We retrospectively reviewed patients with ASAP/multifocal HGPIN undergoing a repeat biopsy in the Michigan Urological Surgery Improvement Collaborative registry. We included men with and without an MRI after the index biopsy demonstrating ASAP/multifocal HGPIN but before the repeat biopsy. Men with an MRI prior to the index biopsy were excluded. We compared the proportion of men with ≥GG2 CaP (Grade Group 2 prostate cancer) on repeat biopsy among the following groups with the χ2 test: no MRI, PIRADS (Prostate Imaging-Reporting and Data System) ≥ 4, and PIRADS ≤3. Multivariable models were used to estimate the adjusted association between MRI findings and ≥GG2 CaP on repeat biopsy. RESULTS Among the 207 men with a previous diagnosis of ASAP/multifocal HGPIN that underwent a repeat biopsy, men with a PIRADS ≥4 lesion had a higher proportion of ≥GG2 CaP (56%) compared with men without an MRI (12%, P < .001). A lower proportion of men with PIRADS ≤3 lesions had ≥ GG2 CaP (3.0%) compared with men without an MRI (12%, P = .13). In the adjusted model, men with a PIRADS 4 to 5 lesion had higher odds (OR: 11.4, P < .001) of ≥ GG2 CaP on repeat biopsy. CONCLUSIONS MRI is a valuable diagnostic tool to triage which men with a history of ASAP or multifocal HGPIN on initial biopsy should undergo or avoid repeat biopsy without missing clinically significant CaP.

中文翻译：

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MRI 能否帮助告知哪些有多灶性高级别前列腺上皮内瘤变或非典型小腺泡增生病史的男性患临床显着前列腺癌的风险仍然较高？

目的 我们调查了先前诊断为非典型小腺泡增生 (ASAP) 或多灶性高级别上皮内瘤变 (HGPIN) 的男性的 MRI 结果与重复活检病理结果之间的关系。材料和方法 我们回顾性审查了在密歇根泌尿外科改进合作登记处接受重复活检的 ASAP/多灶 HGPIN 患者。我们纳入了在索引活检显示 ASAP/多焦点 HGPIN 之后但在重复活检之前接受或未接受 MRI 的男性。在索引活检之前接受过 MRI 检查的男性被排除在外。我们使用 χ2 检验比较了以下各组中重复活检时患有 ≥GG2 CaP（2 级前列腺癌）的男性比例：无 MRI、PIRADS（前列腺成像报告和数据系统）≥ 4 和 PIRADS ≤ 3。使用多变量模型来估计 MRI 结果与重复活检中≥GG2 CaP 之间的调整关联。结果 在 207 名既往诊断为 ASAP/多灶性 HGPIN 并接受重复活检的男性中，与未进行 MRI 的男性相比（12%，P < .001)。与未进行 MRI 的男性相比 (12%，P = .13)，PIRADS ≤ 3 个病变的男性中 ≥ GG2 CaP 的比例较低 (3.0%)。在调整后的模型中，具有 PIRADS 4 至 5 病变的男性在重复活检时 ≥ GG2 CaP 的几率较高（OR：11.4，P < .001）。结论 MRI 是一种有价值的诊断工具，可对初次活检时有 ASAP 或多灶 HGPIN 病史的男性进行分类，应接受或避免重复活检，而不会遗漏临床上显着的 CaP。