From the Department of Radiology (C.E.S., P.D.A., E.N.V., K.R.C.), Department of Medicine/Division of Medical Oncology (P.G.F., D.J.G.), Department of Surgery/Division of Urology (D.J.G.), Duke Cancer Institute (J.D.T., K.K.M., P.G.F., D.J.G.), Department of Pathology/Division of Pathology Clinical Services (J.F.M.), and Institute for Genomic Science and Policy (P.G.F.), Duke University Medical Center, 2301 Erwin Rd, PO Box 3808, Durham, NC 27710.
Radiology. 2013 Dec;269(3):816-23. doi: 10.1148/radiol.13121782. Epub 2013 Oct 28.
To determine the rate at which computed tomographically guided pelvic percutaneous bone biopsy in men with metastatic castration-resistant prostate cancer (mCRPC) yields adequate tissue for genomic profiling and to identify issues likely to affect diagnostic yields.
This study was institutional review board approved, and written informed consent was obtained. In a phase II trial assessing response to everolimus, 31 men with mCRPC underwent 54 biopsy procedures (eight men before and 23 men both before and during treatment). Variables assessed were lesion location (iliac wing adjacent to sacroiliac joint, iliac wing anterior and/or superior to sacroiliac joint, sacrum, and remainder of pelvis), mean lesion attenuation, subjective lesion attenuation (purely sclerotic vs mixed), central versus peripheral lesion sampling, lesion size, core number, and use of zoledronic acid for more than 1 year.
Of 54 biopsy procedures, 21 (39%) yielded adequate tissue for RNA isolation and genomic profiling. Three of four sacral biopsies were adequate. Biopsies of the ilium adjacent to the sacroiliac joints were more likely adequate than those from elsewhere in the ilium (48% vs 28%, respectively). All five biopsies performed in other pelvic locations yielded inadequate tissue for RNA isolation. Mean attenuation of lesions with inadequate tissue was 172 HU greater than those with adequate tissue (621.1 HU ± 166 vs 449 HU ± 221, respectively; P = .002). Use of zoledronic acid, peripheral sampling, core number, and lesion size affected yields, but the differences were not statistically significant. Histologic examination with hematoxylin-eosin staining showed that results of 36 (67%) biopsies were positive for cancer; only mean attenuation differences were significant (707 HU ± 144 vs 473 HU ± 191, negative vs positive, respectively; P < .001).
In men with mCRPC, percutaneous sampling of osseous metastases for genomic profiling is possible, but use of zoledronic acid for more than 1 year may reduce the yield of adequate tissue for RNA isolation. Sampling large low-attenuating lesions at their periphery maximizes yield.
确定在转移性去势抵抗性前列腺癌（mCRPC）男性患者中，计算机断层扫描引导下经皮骨盆骨活检获得足够组织进行基因组分析的比率，并确定可能影响诊断结果的因素。
本研究获得机构审查委员会批准，并获得书面知情同意。在一项评估依维莫司反应的 II 期试验中，31 名 mCRPC 男性患者接受了 54 次活检（8 名男性在治疗前，23 名男性在治疗前和治疗期间）。评估的变量包括病变部位（骶髂关节旁髂骨翼、髂骨翼前上及/或骶髂关节、骶骨和骨盆其余部位）、平均病变衰减值、主观病变衰减（单纯硬化性与混合性）、中央与外周病变取样、病变大小、核心数量以及是否使用唑来膦酸超过 1 年。
54 次活检中，有 21 次（39%）获得了足够的组织进行 RNA 分离和基因组分析。4 次骶骨活检中有 3 次是充分的。与髂骨其他部位的活检相比，骶髂关节旁髂骨的活检更有可能获得充分的组织（分别为 48%和 28%）。在其他骨盆部位进行的 5 次活检均未能获得足够的 RNA 分离用组织。组织学检查显示，有足够组织的病变平均衰减值比无足够组织的病变高 172HU（分别为 621.1HU±166 和 449HU±221，P=0.002）。使用唑来膦酸、外周取样、核心数量和病变大小均影响了活检结果，但差异无统计学意义。使用苏木精-伊红染色进行组织学检查显示，36 次（67%）活检结果为阳性，只有平均衰减差异有统计学意义（分别为 707HU±144 和 473HU±191，阴性和阳性，P<0.001）。
在 mCRPC 男性中，经皮骨转移取样进行基因组分析是可行的，但使用唑来膦酸超过 1 年可能会降低 RNA 分离用足够组织的产量。在外周取样大的低衰减病变可最大限度地提高产量。
