1 Department of Medical Imaging, Robarts Research Institute, University of Western Ontario, London, ON, Canada.
AJR Am J Roentgenol. 2015 Jan;204(1):83-91. doi: 10.2214/AJR.14.12681.
The purpose of this article is to compare transrectal ultrasound (TRUS) biopsy accuracies of operators with different levels of prostate MRI experience using cognitive registration versus MRI-TRUS fusion to assess the preferred method of TRUS prostate biopsy for MRI-identified lesions. SUBJECTS AND METHODS; One hundred patients from a prospective prostate MRI-TRUS fusion biopsy study were reviewed to identify all patients with clinically significant prostate adenocarcinoma (PCA) detected on MRI-targeted biopsy. Twenty-five PCA tumors were incorporated into a validated TRUS prostate biopsy simulator. Three prostate biopsy experts, each with different levels of experience in prostate MRI and MRI-TRUS fusion biopsy, performed a total of 225 simulated targeted biopsies on the MRI lesions as well as regional biopsy targets. Simulated biopsies performed using cognitive registration with 2D TRUS and 3D TRUS were compared with biopsies performed under MRI-TRUS fusion.
Two-dimensional and 3D TRUS sampled only 48% and 45% of clinically significant PCA MRI lesions, respectively, compared with 100% with MRI-TRUS fusion. Lesion sampling accuracy did not statistically significantly vary according to operator experience or tumor volume. MRI-TRUS fusion-naïve operators showed consistent errors in targeting of the apex, midgland, and anterior targets, suggesting that there is biased error in cognitive registration. The MRI-TRUS fusion expert correctly targeted the prostate apex; however, his midgland and anterior mistargeting was similar to that of the less-experienced operators.
MRI-targeted TRUS-guided prostate biopsy using cognitive registration appears to be inferior to MRI-TRUS fusion, with fewer than 50% of clinically significant PCA lesions successfully sampled. No statistically significant difference in biopsy accuracy was seen according to operator experience with prostate MRI or MRI-TRUS fusion.
本文旨在比较不同前列腺 MRI 经验水平的操作者在使用认知配准和 MRI-TRUS 融合评估 MRI 识别病变的 TRUS 前列腺活检首选方法时的经直肠超声（TRUS）活检准确性。
回顾了一项前瞻性前列腺 MRI-TRUS 融合活检研究中的 100 例患者，以确定所有在 MRI 靶向活检中检测到的临床显著前列腺腺癌（PCA）患者。25 个 PCA 肿瘤被纳入一个经过验证的 TRUS 前列腺活检模拟器中。三名前列腺活检专家，每人在前列腺 MRI 和 MRI-TRUS 融合活检方面的经验水平不同，对 MRI 病变以及区域活检靶区总共进行了 225 次模拟靶向活检。使用认知配准与 2D TRUS 和 3D TRUS 进行的模拟活检与 MRI-TRUS 融合下进行的活检进行了比较。
二维和三维 TRUS 分别仅对 48%和 45%的临床显著 PCA MRI 病变进行了采样，而 MRI-TRUS 融合则为 100%。根据操作者经验或肿瘤体积，病变采样准确性没有统计学上的显著差异。MRI-TRUS 融合新手操作者在靶向前列腺尖部、中叶和前叶靶区时始终存在误差，这表明认知配准存在有偏误差。MRI-TRUS 融合专家正确靶向前列腺尖部；然而，他的中叶和前叶靶向错误与经验较少的操作者相似。
使用认知配准的 MRI 靶向 TRUS 引导前列腺活检似乎不如 MRI-TRUS 融合，不到 50%的临床显著 PCA 病变成功采样。根据操作者在前列腺 MRI 或 MRI-TRUS 融合方面的经验，活检准确性没有统计学上的显著差异。
