Borkowetz Angelika, Platzek Ivan, Toma Marieta, Laniado Michael, Baretton Gustavo, Froehner Michael, Koch Rainer, Wirth Manfred, Zastrow Stefan
Department of Urology, Technische Universität, Dresden, Germany.
Department of Radiology and Interventional Radiology, Technische Universität, Dresden, Germany.
BJU Int. 2015 Dec;116(6):873-9. doi: 10.1111/bju.13023. Epub 2015 Apr 27.
To compare targeted, transperineal magnetic resonance imaging (MRI)/ultrasound (US)-fusion biopsy to systematic transrectal biopsy in patients with previous negative or first prostate biopsy and to evaluate the gain in diagnostic information with systematic biopsies in addition to targeted MRI/US-fusion biopsies.
In all, 263 consecutive patients with suspicion of prostate cancer were investigated. All patients were evaluated by 3-T multiparametric MRI (mpMRI) applying the European Society of Urogenital Radiology criteria. All patients underwent MRI/US-fusion biopsy transperineally (mean nine cores) and additionally a systematic transrectal biopsy (mean 12 cores).
In all, 195 patients underwent repeat biopsy and 68 patients underwent first biopsy. The median age was 66 years, median PSA level was 8.3 ng/mL and median prostate volume was 50 mL. Overall, the prostate cancer detection rate was 52% (137/263). MRI/US-fusion biopsy detected significantly more cancer than systematic prostate biopsy (44% [116/263] vs 35% [91/263]; P = 0.002). In repeat biopsy, the detection rate was 44% (85/195) in targeted and 32% (62/195) in systematic biopsy (P = 0.002). In first biopsy, the detection rate was 46% (31/68) in targeted and 43% (29/68) in systematic biopsy (P = 0.527). In all, 80% (110/137) of biopsy confirmed prostate cancers were clinically significant. For the upgrading of Gleason score, 44% (32/72) more clinically significant prostate cancer was detected by using additional targeted biopsy than by systematic biopsy alone. Conversely, 12% (10/94) more clinically significant cancer was found by systematic biopsy additionally to targeted biopsy.
MRI/US-fusion biopsy was associated with a higher detection rate of clinically significant prostate cancer while taking fewer cores, especially in patients with prior negative biopsy. Due to a high portion of additional tumours with Gleason score ≥7 detected in addition to targeted biopsy, systematic biopsy should still be performed additionally to targeted biopsy.
比较经会阴靶向磁共振成像（MRI）/超声（US）融合活检与系统性经直肠活检在既往前列腺活检阴性或初次活检患者中的应用，并评估在靶向MRI/US融合活检基础上进行系统性活检所获得的诊断信息增益。
共纳入263例疑似前列腺癌的连续患者。所有患者均按照欧洲泌尿生殖放射学会标准接受3-T多参数MRI（mpMRI）评估。所有患者均经会阴接受MRI/US融合活检（平均9针），并额外进行系统性经直肠活检（平均12针）。
195例患者接受了重复活检，68例患者接受了初次活检。中位年龄为66岁，中位前列腺特异性抗原（PSA）水平为8.3 ng/mL，中位前列腺体积为50 mL。总体而言，前列腺癌检出率为52%（137/263）。MRI/US融合活检检测到的癌症明显多于系统性前列腺活检（44%[116/263]对35%[91/263]；P = 0.002）。在重复活检中，靶向活检的检出率为44%（85/195），系统性活检的检出率为32%（62/195）（P = 0.002）。在初次活检中，靶向活检的检出率为46%（31/68），系统性活检的检出率为43%（29/68）（P = 0.527）。活检确诊的前列腺癌中，80%（110/137）具有临床意义。对于Gleason评分升级，与仅进行系统性活检相比，额外进行靶向活检可多检测出44%（32/72）具有临床意义的前列腺癌。相反，在靶向活检基础上进行系统性活检可多发现12%（10/94）具有临床意义的癌症。
MRI/US融合活检在获取较少针数的情况下，对具有临床意义的前列腺癌的检出率更高，尤其是在既往活检阴性的患者中。由于在靶向活检之外还检测到相当一部分Gleason评分≥7的额外肿瘤，因此除靶向活检外仍应额外进行系统性活检。
