Acar Ömer, Esen Tarık, Çolakoğlu Bülent, Vural Metin, Onay Aslıhan, Sağlıcan Yeşim, Türkbey Barış, Rozanes İzzet
Department of Urology, Koç University School of Medicine, Istanbul, Turkey.
Diagn Interv Radiol. 2015 Jul-Aug;21(4):271-6. doi: 10.5152/dir.2015.46014.
With the increased recognition of the capabilities of prostate multiparametric (mp) magnetic resonance imaging (MRI), attempts are being made to incorporate MRI into routine prostate biopsies. In this study, we aimed to analyze the diagnostic yield via cognitive fusion, transrectal ultrasound (TRUS)-guided, and in-bore MRI-guided biopsies in biopsy-naive patients with positive findings for prostate cancer screening.
Charts of 140 patients, who underwent transrectal prostate biopsy after the adaptation of mp-MRI into our routine clinical practice, were reviewed retrospectively. Patients with previous negative biopsies (n=24) and digital rectal examination findings suspicious for ≥cT3 prostate cancer (n=16) were excluded. T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging were included in mp-MRI. Cognitive fusion biopsies were performed after a review of mp-MRI data, whereas TRUS-guided biopsies were performed blinded to MRI information. In-bore biopsies were conducted by means of real-time targeting under MRI guidance.
Between January 2012 and February 2014, a total of 100 patients fulfilling the inclusion criteria underwent TRUS-guided (n=37), cognitive fusion (n=49), and in-bore (n=14) biopsies. Mean age, serum prostate specific antigen level, and prostate size did not differ significantly among the study groups. In TRUS-guided biopsy group, 51.3% were diagnosed with prostate cancer, while the same ratio was 55.1% and 71.4% in cognitive fusion and in-bore biopsy groups, respectively (P = 0.429). Clinically significant prostate cancer detection rate was 69.1%, 70.3%, and 90% in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively (P = 0.31). According to histopathologic variables in the prostatectomy specimen, significant prostate cancer was detected in 85.7%, 93.3%, and 100% of patients in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively.
In the first set of transrectal prostate biopsies, mp-MRI guidance did not increase the diagnostic yield significantly.
随着对前列腺多参数（mp）磁共振成像（MRI）功能的认识不断提高，人们试图将MRI纳入常规前列腺活检。在本研究中，我们旨在分析在前列腺癌筛查结果呈阳性的初诊患者中，通过认知融合、经直肠超声（TRUS）引导和孔内MRI引导活检的诊断率。
回顾性分析了140例在我们将mp-MRI纳入常规临床实践后接受经直肠前列腺活检的患者的病历。排除既往活检阴性（n = 24）和直肠指检结果怀疑为≥cT3前列腺癌（n = 16）的患者。mp-MRI包括T2加权成像、扩散加权成像和动态对比增强成像。在回顾mp-MRI数据后进行认知融合活检，而TRUS引导活检在不了解MRI信息的情况下进行。孔内活检通过MRI引导下的实时靶向进行。
2012年1月至2014年2月，共有100例符合纳入标准的患者接受了TRUS引导（n = 37）、认知融合（n = 49）和孔内（n = 14）活检。各研究组之间的平均年龄、血清前列腺特异性抗原水平和前列腺大小无显著差异。在TRUS引导活检组中，51.3%被诊断为前列腺癌，而在认知融合和孔内活检组中，这一比例分别为55.1%和71.4%（P = 0.429）。在TRUS引导、认知融合和孔内活检组中，临床显著前列腺癌的检出率分别为69.1%、70.3%和90%（P = 0.31）。根据前列腺切除标本的组织病理学变量，在TRUS引导、认知融合和孔内活检组中，分别有85.7%、93.3%和100%的患者检测到显著前列腺癌。
在首次经直肠前列腺活检中，mp-MRI引导并未显著提高诊断率。
