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mpMRIに基づく自動前立腺生検意思決定におけるGPT-4の性能：多施設エビデンス研究

  • role： Contribute equally, First author同等贡献者, 第一作者
  • Affiliation：

    Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

    Institute of Urology, Beijing Municipal Health Commission, Beijing 101313, China

Ming-Jun Shi12,  
  • role： Contribute equally同等贡献者
  • Affiliation：

    Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

    Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Zhi-Xiang Wang34,  
  • role： Contribute equally同等贡献者
  • Affiliation：

    Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Shuang-Kun Wang5,  
  • Affiliation：

    Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Xuan-Hao Li1,  
  • Affiliation：

    Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Yan-Lin Zhang6,  
  • Affiliation：

    Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Ying Yan3,  
  • Affiliation：

    Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Ran An3,  
  • Affiliation：

    Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Li-Ning Dong3,  
  • Affiliation：

    Department of Urology, Peking University Third Hospital, Beijing 100083, China

Lei Qiu7,  
  • Affiliation：

    Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Tian Tian5,  
  • Affiliation：

    Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

    Department of Urology, Beijing Fuxing Hospital, Capital Medical University, Beijing 100039, China

Jia-Xin Liu18,  
  • Affiliation：

    Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Hong-Chen Song1,  
  • Affiliation：

    Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Ya-Fan Wang5,  
  • Affiliation：

    Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Che Deng5,  
  • Affiliation：

    Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

    Department of Urology, Beijing Miyun District Traditional Chinese Medicine Hospital, Beijing 101500, China

Zi-Bing Cao19,  
  • Affiliation：

    Department of Urology, Peking University Third Hospital, Beijing 100083, China

Hong-Yin Wang7,  
  • Affiliation：

    Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Zheng Wang3,  
  • Affiliation：

    Division of Science and Technology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Wei Wei10,  
  • role： Corresponding author通信作者
  • Affiliation：

    Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

    Institute of Urology, Beijing Municipal Health Commission, Beijing 101313, China

  • Email：songjian1974@aliyun.com
  • Introduction：* Jian Song songjian1974@aliyun.com
Jian Song12*,  
  • role： Corresponding author通信作者
  • Affiliation：

    Department of Urology, Peking University Third Hospital, Beijing 100083, China

  • Email：lujian@bjmu.edu.cn
  • Introduction：Jian Lu lujian@bjmu.edu.cn
Jian Lu7*,  
  • role： Corresponding author通信作者
  • Affiliation：

    Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

  • Email：weixuan315@163.com
  • Introduction：Xuan Wei weixuan315@163.com
Xuan Wei3*,  
  • role： Corresponding author通信作者
  • Affiliation：

    Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

  • Email：cjr.wzhch@vip.163.com
  • Introduction：Zhen-Chang Wang cjr.wzhch@vip.163.com
Zhen-Chang Wang3*

サマリー

多重パラメトリック磁気共鳴画像法（mpMRI）は前立腺がん（PCa）の検出を大きく進歩させましたが、中程度の前立腺画像報告およびデータシステム（PI-RADS）スコアにおける侵襲的生検の決定は依然あいまいです。自動前立腺生検推奨のための生成事前学習済みトランスフォーマー-4（GPT-4）の意思決定能力を探るために、2018年から2023年にかけて3つの大規模医療センターで前立腺生検を受け、事前にmpMRIを取得し臨床病理記録が文書化された2299名を対象としました。GPT-4は指定されたプロンプトで構造化レポートを生成しました。GPT-4の性能は混同行列を用いて定量化され、感度、特異度、および曲線下面積が算出されました。複数の人工評価手順が実施されました。比較にはウィルコクソン順位和検定、フィッシャーの正確確率検定、およびクラスカル・ウォリス検定が使用されました。中国人集団で最大のサンプルサイズを活用し、中程度のPI-RADSスコア（3および4）の患者は39.7％（912/2299）を占め、関心サブセット（SOI）と定義されました。PI-RADSスコア2～5に対応する臨床的に有意なPCaの検出率はそれぞれ9.4％、27.3％、49.2％、80.1％でした。SOI患者の約47.5％（433/912）は不要な前立腺生検を受けたことが組織学的に証明されました。GPT-4の支援により、SOI集団の20.8％（190/912）が不要な生検を回避でき、最も異質なPI-RADSスコア3のサブグループではより良い成績[28.8％（118/410）]を示しました。GPT-4生成のレポートの90.0％以上が包括的で理解しやすかった一方、正確性にはやや満足できませんでした（82.8％）。GPT-4は複雑な問題を扱う認知的能力も示しました。さらに、連鎖思考法によりGPT-4の意思決定ロジックをより深く理解することができました。最終的に、医師と患者の両方のアクセスを促進するためにProstAIGuideプラットフォームを開発しました。この多施設研究は、前立腺生検の意思決定におけるGPT-4の臨床的有用性を強調し、様々な医療シナリオにおける最新の人工知能実装に対する理解を深めます。

キーワード

前立腺生検; 生成事前学習済みトランスフォーマー-4 (GPT-4); 意思決定; 前立腺癌; 多重パラメトリック磁気共鳴画像法 (mpMRI)

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