Bittner Nathan, Merrick Gregory S, Bennett Abbey, Butler Wayne M, Andreini Hugo J, Taubenslag Walter, Adamovich Edward
*Tacoma/Valley Radiation Oncology Centers, Tacoma, WA †Schiffler Cancer Center, Wheeling Hospital, Wheeling Jesuit University Departments of ‡Urology §Pathology, Wheeling Hospital, Wheeling, WV.
Am J Clin Oncol. 2015 Jun;38(3):300-3. doi: 10.1097/COC.0b013e31829a2954.
To evaluate the utility of transperineal template-guided mapping biopsy (TTMB) of the prostate as an initial means of establishing tissue diagnosis.
A total of 191 consecutive patients underwent TTMB of the prostate using an anatomic-based technique with sampling of 24 regions. All patients had elevated prostate-specific antigen on routine screening which was followed by a confirmatory prostate-specific antigen and none had undergone previous biopsy of the prostate. The locations of cancer involvement were recorded for each patient in an effort to approximate the percentage of men whose cancer would have been missed or Gleason score underestimated on a standard 12-core biopsy. The median number of submitted biopsy cores was 54.0.
Of the 191 study patients, 140 (73.3%) were diagnosed with cancer on TTMB. Among these biopsy-positive patients, 124 (88.6%) had clinically significant cancer. Eighty-nine of the biopsy-positive patients (64.6%) had a Gleason score of ≥7. A total of 34 of the 140 diagnosed cancers were identified exclusively in regions that fell outside of the theoretical 12-core biopsy scheme, suggesting that 24.3% of these cancers would have gone undiagnosed in the absence of TTMB. Among the 107 cancers that would have been diagnosed using a 12-core biopsy approach, 18 (16.8%) were upgraded to a Gleason score of ≥7 with mapping biopsy.
TTMB appears to provide more detailed information about prostate cancer grade and location compared with standard 12-core biopsy scheme. This information may serve as a baseline reference for image-guided biopsy (ie, magnetic resonance imaging) regimens, may facilitate clinical decision making and aid in the appropriate selection of patients for active surveillance.
评估经会阴模板引导下前列腺穿刺活检（TTMB）作为建立组织诊断的初始手段的效用。
共191例连续患者采用基于解剖学的技术对前列腺进行TTMB，对24个区域进行采样。所有患者在常规筛查时前列腺特异性抗原升高，随后进行了确诊性前列腺特异性抗原检测，且均未接受过前列腺穿刺活检。记录每位患者癌症累及的位置，以估算在标准12针穿刺活检中癌症可能被漏诊或Gleason评分被低估的男性比例。送检穿刺针数的中位数为54.0。
191例研究患者中，140例（73.3%）经TTMB诊断为癌症。在这些穿刺活检阳性的患者中，124例（88.6%）患有临床意义显著的癌症。89例穿刺活检阳性患者（64.6%）的Gleason评分为≥7分。140例确诊癌症中，共有34例仅在理论12针穿刺活检方案之外的区域被发现，这表明在没有TTMB的情况下，这些癌症中有24.3%会未被诊断出来。在使用12针穿刺活检方法可诊断出的107例癌症中，有18例（16.8%）在穿刺活检后Gleason评分升级为≥7分。
与标准12针穿刺活检方案相比，TTMB似乎能提供更多关于前列腺癌分级和位置的详细信息。这些信息可作为图像引导活检（即磁共振成像）方案的基线参考，可能有助于临床决策，并有助于适当选择进行主动监测的患者。
