Centre for Medical Image Computing, University College London (UCL), London, UK.
BJU Int. 2012 Sep;110(6):812-20. doi: 10.1111/j.1464-410X.2012.10933.x. Epub 2012 Mar 6.
What's known on the subject? and What does the study add? Transrectal ultrasonography (TRUS)-guided biopsies can miss prostate cancer and misclassify risk in a diagnostic setting; the exact extent to which it does so in a repeat biopsy strategy in men with low-intermediate risk prostate cancer is unknown. A simulation study of different biopsy strategies showed that repeat 12-core TRUS biopsy performs poorly. Adding anterior sampling improves on this but the highest accuracy is achieved using transperineal template prostate mapping using a 5 mm sampling frame.
To determine the effectiveness of two sampling strategies; repeat transrectal ultrasonography (TRUS)-biopsy and transperineal template prostate mapping (TPM) to detect and exclude lesions of ≥0.2 mL or ≥0.5 mL using computer simulation on reconstructed three-dimensional (3-D) computer models of radical whole-mount specimens.
Computer simulation on reconstructed 3-D computer models of radical whole-mount specimens was used to evaluate the performance characteristics of repeat TRUS-biopsy and TPM to detect and exclude lesions of ≥0.2 mL or ≥0.5 mL. In all, 107 consecutive cases were analysed (1999-2001) with simulations repeated 500 times for each biopsy strategy. TPM and five different TRUS-biopsy strategies were simulated; the latter involved a standard 12-core sampling and incorporated variable amounts of error, as well as the addition of anterior cores. Sensitivity, specificity, negative and positive predictive values for detection of lesions with a volume of ≥0.2 mL or ≥0.5 mL were calculated.
The mean (SD) age and PSA concentration were 61 (6.4) years and 8.5 (5.9) ng/mL, respectively.In all, 53% (57/107) had low-intermediate risk disease. In all, 665 foci were reconstructed; there were 149 foci ≥0.2 mL and 97 ≥ 0.5 mL in the full cohort and 68 ≥ 0.2 mL and 43 ≥ 0.5 mL in the low-intermediate risk group. Overall, TPM accuracy (area under the receiver operating curve, AUC) was ≈0.90 compared with AUC 0.70-0.80 for TRUS-biopsy. In addition, at best, TRUS-biopsy missed 30-40% of lesions of ≥0.2 mL and ≥0.5 mL whilst TPM missed 5% of such lesions.
TPM under simulation conditions appears the most effective re-classification strategy, although augmented TRUS-biopsy techniques are better than standard TRUS-biopsy.
使用计算机模拟在根治性全切除标本的三维（3-D）重建计算机模型上，确定两种采样策略（重复经直肠超声（TRUS）活检和经会阴模板前列腺图谱（TPM））检测和排除≥0.2 毫升或≥0.5 毫升病变的有效性。
使用计算机模拟在根治性全切除标本的三维（3-D）重建计算机模型上评估重复经直肠超声（TRUS）活检和 TPM 检测和排除≥0.2 毫升或≥0.5 毫升病变的性能特征。对 107 例连续病例（1999-2001 年）进行了分析（n=107），对每种活检策略重复模拟 500 次。模拟了 TPM 和五种不同的 TRUS 活检策略；后者涉及标准的 12 核采样，并纳入了不同量的误差，以及增加了前核。计算了检测体积≥0.2 毫升或≥0.5 毫升病变的灵敏度、特异性、阴性和阳性预测值。
平均（SD）年龄和 PSA 浓度分别为 61（6.4）岁和 8.5（5.9）ng/ml，分别为 53%（57/107）患有低中度危险疾病。共重建了 665 个病灶；在整个队列中，有 149 个病灶≥0.2 毫升，97 个病灶≥0.5 毫升，在低中度风险组中，有 68 个病灶≥0.2 毫升，43 个病灶≥0.5 毫升。总体而言，TPM 的准确性（接收器工作特征曲线下面积，AUC）约为 0.90，而 TRUS 活检的 AUC 为 0.70-0.80。此外，在最佳情况下，TRUS 活检漏诊了 30-40%的≥0.2 毫升和≥0.5 毫升病变，而 TPM 漏诊了 5%的此类病变。
在模拟条件下，TPM 似乎是最有效的重新分类策略，尽管增强的 TRUS 活检技术优于标准 TRUS 活检。
