Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
J Urol. 2011 Dec;186(6):2214-20. doi: 10.1016/j.juro.2011.07.102. Epub 2011 Oct 19.
We developed an effective way to precisely diagnose prostate cancer using a novel prostate biopsy system that integrates pre-interventional magnetic resonance imaging with peri-interventional ultrasound for perineal navigated prostate biopsy.
A total of 106 men with findings suspicious for prostate cancer (median age 66 years, prostate specific antigen 8.0 ng/ml and prostate volume 47 ml) underwent multiparametric 3 Tesla magnetic resonance imaging. Suspicious lesions were marked and data were transferred to the novel biopsy system. Using a custom-made biplane transrectal ultrasound probe mounted on a stepper we gathered 3-dimensional ultrasound data and fused them with magnetic resonance imaging data. As a result, suspicious magnetic resonance imaging lesions were superimposed over the transrectal ultrasound data. Three-dimensional biopsy planning was done, including systematic biopsies. Perineal biopsies were taken under live ultrasound guidance and the precise site of each biopsy was documented in 3 dimensions. We evaluated feasibility, safety and cancer detection.
Prostate cancer was detected in 63 of 106 patients (59.4%). Magnetic resonance imaging findings correlated positively with histopathology in 71 of 103 patients (68.9%). In magnetic resonance imaging lesions marked as highly suspicious, the detection rate was 95.8% (23 of 24 cases). Lesion targeted cores had a significantly higher positivity rate than nontargeted cores. The procedural targeting error of the first 2,461 biopsy cores was 1.7 mm. Regarding adverse effects, 2 patients experienced urinary retention and 1 had a perineal hematoma. Urinary tract infections did not develop.
Perineal stereotactic prostate biopsies guided by the combination of magnetic resonance imaging and ultrasound enable effective examination of suspicious magnetic resonance imaging lesions. Each biopsy core taken is documented accurately for its location in 3 dimensions, enabling magnetic resonance imaging validation and tailored treatment planning. The morbidity of the procedure was minimal.
我们开发了一种使用新型前列腺活检系统精确诊断前列腺癌的有效方法，该系统将介入前磁共振成像与经会阴导航前列腺活检的介入期间超声相结合。
106 名前列腺癌可疑患者（中位年龄 66 岁，前列腺特异性抗原 8.0ng/ml，前列腺体积 47ml）接受了多参数 3T 磁共振成像检查。可疑病变标记，并将数据传输到新型活检系统。使用安装在步进器上的定制双平面经直肠超声探头，我们收集了 3 维超声数据，并将其与磁共振成像数据融合。结果，可疑磁共振成像病变叠加在经直肠超声数据上。进行了 3 维活检计划，包括系统活检。在实时超声引导下进行经会阴活检，并在 3 个维度上记录每个活检的精确位置。我们评估了可行性、安全性和癌症检出率。
106 例患者中 63 例（59.4%）检出前列腺癌。103 例患者中 71 例（68.9%）磁共振成像发现与组织病理学结果呈正相关。在标记为高度可疑的磁共振成像病变中，检出率为 95.8%（23 例/24 例）。靶向病变的核心活检阳性率明显高于非靶向核心活检。前 2461 个活检核心的程序靶向误差为 1.7mm。关于不良事件，2 例患者出现尿潴留，1 例患者出现会阴血肿。未发生尿路感染。
磁共振成像和超声联合引导的经会阴立体定向前列腺活检能够有效检查可疑磁共振成像病变。每个采集的活检核心都准确记录其在 3 个维度上的位置，实现磁共振成像验证和定制治疗计划。该程序的发病率很低。
