van Hove Antoine, Savoie Pierre-Henri, Maurin Charlotte, Brunelle Serge, Gravis Gwenaëlle, Salem Naji, Walz Jochen
Department of Urology, Institut Paoli-Calmettes Cancer Centre, 232, Boulevard Ste. Marguerite, BP 156, 13273, Marseille, France.
World J Urol. 2014 Aug;32(4):847-58. doi: 10.1007/s00345-014-1332-3. Epub 2014 Jun 12.
The clinical utility of image-targeted biopsies can only be judged by a comparison of the current standard of systematic 10-12 core biopsy schemes. The aim of this review was to gather the current evidence in favor of or against targeted biopsies in the detection of prostate cancer based on well-designed, controlled studies, in order to draw clinical relevant conclusions.
SUBJECTS/PATIENTS AND METHODS: A systematic literature review was performed addressing studies that compared the prostate cancer detection rates of targeted and systematic biopsy schemes using the imaging techniques of elastography, contrast-enhanced ultrasound, histoscanning and multiparametric MRI. Only well-designed, controlled studies were included and the results summarized.
All imaging techniques are associated with varying results regarding better or poorer detection rates relative to systematic biopsies. No technique provides a clear trend in favor of or against image-targeted biopsies. In almost all studies, the combination of targeted and systematic biopsies provided sometimes a substantial, increase in the detection rate relative to systematic biopsies alone. MRI-targeted biopsies show no advantage in the initial biopsy setting, whereas in the repeat biopsy setting improvements in the detection rates are often observed relative to systemic biopsies.
Based on well-designed, controlled studies no clear advantage of targeted biopsies over the current standard of systematic biopsies can be observed. Therefore, targeted biopsies cannot replace systematic biopsies in the diagnosis of prostate cancer. In all indications, the combination of systematic and targeted biopsy schemes provides the highest detection rate.
图像引导活检的临床实用性只能通过与当前系统性10-12针活检方案的标准进行比较来判断。本综述的目的是基于精心设计的对照研究，收集目前支持或反对靶向活检检测前列腺癌的证据，以便得出临床相关结论。
受试者/患者与方法：进行了一项系统性文献综述，涉及比较使用弹性成像、超声造影、组织扫描和多参数MRI等成像技术的靶向活检方案与系统性活检方案的前列腺癌检测率的研究。仅纳入精心设计的对照研究并总结结果。
所有成像技术与系统性活检相比，在检测率高低方面都有不同结果。没有一种技术呈现出支持或反对图像引导活检的明确趋势。在几乎所有研究中，靶向活检与系统性活检相结合有时相对于单独的系统性活检能显著提高检测率。MRI引导活检在初次活检时没有优势，而在重复活检时，相对于系统性活检，检测率通常会提高。
基于精心设计的对照研究，未观察到靶向活检相对于当前系统性活检标准有明显优势。因此，在前列腺癌诊断中，靶向活检不能取代系统性活检。在所有适应症中，系统性活检与靶向活检方案相结合可提供最高的检测率。
