Jung Adam J, Westphalen Antonio C, Kurhanewicz John, Wang Zhen J, Carroll Peter R, Simko Jeffry P, Coakley Fergus V
Departments of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA.
J Magn Reson Imaging. 2014 Aug;40(2):314-23. doi: 10.1002/jmri.24383. Epub 2013 Oct 31.
To investigate the potential clinical utility of endorectal MRI-guided biopsy in patients with known or suspected prostate cancer.
We prospectively recruited 24 men with known or suspected prostate cancer in whom MRI-guided biopsy was clinically requested after multiparametric endorectal MRI showed one or more appropriate targets. One to six 18-gauge biopsy cores were obtained from each patient. Transrectal ultrasound guided biopsy results and post MRI-guided biopsy complications were also recorded.
MRI-guided biopsy was positive in 5 of 7 patients with suspected prostate cancer (including 2 of 4 with prior negative ultrasound-guided biopsies), in 8 of 12 with known untreated prostate cancer (including 5 where MRI-guided biopsy demonstrated a higher Gleason score than ultrasound guided biopsy results), and in 3 of 5 with treated cancer. MRI-guided biopsies had a significantly higher maximum percentage of cancer in positive cores when compared with ultrasound guided biopsy (mean of 37 ± 8% versus 13 ± 4%; P = 0.01). No serious postbiopsy complications occurred.
Our preliminary experience suggests endorectal MRI-guided biopsy may safely contribute to the management of patients with known or suspected prostate cancer by making a new diagnosis of malignancy, upgrading previously diagnosed disease, or diagnosing local recurrence.
探讨直肠内磁共振成像（MRI）引导下活检在已知或疑似前列腺癌患者中的潜在临床应用价值。
我们前瞻性招募了24例已知或疑似前列腺癌的男性患者，这些患者在多参数直肠内MRI显示一个或多个合适靶点后，临床上要求进行MRI引导下活检。从每位患者获取1至6个18号活检组织条。还记录经直肠超声引导下活检结果及MRI引导下活检后的并发症。
在7例疑似前列腺癌患者中，5例MRI引导下活检呈阳性（包括4例之前超声引导下活检为阴性的患者中的2例）；在12例已知未治疗的前列腺癌患者中，8例呈阳性（包括5例MRI引导下活检显示Gleason评分高于超声引导下活检结果的患者）；在5例已接受治疗的癌症患者中，3例呈阳性。与超声引导下活检相比，MRI引导下活检阳性组织条中癌组织的最大百分比显著更高（分别为37±8%和13±4%；P = 0.01）。未发生严重的活检后并发症。
我们的初步经验表明，直肠内MRI引导下活检通过做出新的恶性肿瘤诊断、提升先前诊断疾病的分级或诊断局部复发，可能安全地有助于已知或疑似前列腺癌患者的管理。
