多参数磁共振成像/超声融合活检在主动监测中的作用。
The Role of Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Biopsy in Active Surveillance.
机构信息
The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Eur Urol. 2017 Feb;71(2):174-180. doi: 10.1016/j.eururo.2016.05.021. Epub 2016 May 25.
BACKGROUND
Multiparametric magnetic resonance imaging (mpMRI)/ultrasound fusion biopsy (targeted biopsy or TB) may improve detection of high-grade cancers when compared to systematic biopsy (SB).
OBJECTIVE
To assess TB in active surveillance (AS).
DESIGN, SETTING, AND PARTICIPANTS: We retrospectively evaluated SB (12-core sector) and TB among 103 AS men undergoing surveillance biopsy, 54 men undergoing confirmatory biopsy (CB), and 73 men referred for diagnostic biopsy (DB; comparison group). Regions of interest (ROIs) on mpMRI were assigned a PI-RADS score and targeted if the score was ≥3.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Detection of Gleason score (GS) ≥7 by TB and SB was the outcome of interest, except in a multivariable model, for which any cancer was the outcome.
RESULTS AND LIMITATIONS
GS ≥7was detected by either biopsy method in 25 men (24.3%) in the AS group, 12 men (22.2%) in the CB group, and 55 men (75.3%) in the DB group.GS ≥7 was found in 24.3% by SB + TB versus 20.4% by SB in the AS group (p=0.13); in 22.2% by SB + TB versus 16.7% by SB in the CB group (p=0.25); and in 75.3% by SB + TB versus 58.9% by SB in the DB group (p=0.002). The sensitivity for GS ≥7 detection was lower for TB than for SB (p=0.006) in the AS cohort (relative sensitivity ratio 0.33, 95% confidence interval 0.16-0.71). Higher PI-RADS score (4 vs 3, odds ratio [OR] 2.00, p=0.04; 5 vs 3, OR 4.74, p=0.02), lower MRI-estimated prostate volume (OR 1.20 per 10-cm lower volume, p=0.01), larger ROI (OR 1.04 per mm, p=0.02), and right-sided ROI (OR 2.27, p=0.01) were associated with finding cancer on TB. A potential limitation is that not all men who presented for biopsy underwent TB and the urologist was not blinded to MRI results before SB.
CONCLUSIONS
Owing to the low relative sensitivity of mpMRI for detection of GS ≥7 disease, SB still needs to be performed for men on AS.
PATIENT SUMMARY
This study suggests that image-guided prostate biopsy alone may not be informative for men enrolled in an active surveillance program for prostate cancer.
背景
与系统活检（SB）相比，多参数磁共振成像（mpMRI）/超声融合活检（靶向活检或 TB）可能提高高级别癌症的检出率。
目的
评估 TB 在主动监测（AS）中的应用。
设计、地点和参与者：我们回顾性评估了 103 例接受监测活检的 AS 男性、54 例接受确认性活检（CB）的男性和 73 例接受诊断性活检（DB；对照组）的 SB（12 核扇形）和 TB。mpMRI 上的感兴趣区域（ROI）根据 PI-RADS 评分进行赋值，如果评分≥3，则进行靶向活检。
测量和统计分析
TB 和 SB 检测到的 Gleason 评分（GS）≥7 是主要观察终点，除了在多变量模型中，以任何癌症作为观察终点。
结果和局限性
在 AS 组中，25 名（24.3%）男性、12 名（22.2%）CB 组男性和 73 名（75.3%）DB 组男性通过活检方法检测到 GS≥7。AS 组中，SB+TB 检出 GS≥7 的比例为 24.3%，SB 为 20.4%（p=0.13）；在 CB 组中，SB+TB 检出 GS≥7 的比例为 22.2%，SB 为 16.7%（p=0.25）；在 DB 组中，SB+TB 检出 GS≥7 的比例为 75.3%，SB 为 58.9%（p=0.002）。在 AS 队列中，TB 检测 GS≥7 的敏感性低于 SB（p=0.006）（相对敏感性比 0.33，95%置信区间 0.16-0.71）。更高的 PI-RADS 评分（4 分 vs 3 分，比值比 [OR] 2.00，p=0.04；5 分 vs 3 分，OR 4.74，p=0.02）、更低的 MRI 估计前列腺体积（OR 每 10cm 降低 1.20，p=0.01）、更大的 ROI（OR 每 1mm 增加 1.04，p=0.02）和右侧 ROI（OR 2.27，p=0.01）与 TB 上发现癌症有关。一个潜在的局限性是，并非所有接受活检的男性都进行了 TB，并且在 SB 之前，泌尿科医生并不知道 MRI 结果。
结论
由于 mpMRI 对 GS≥7 疾病的检出率相对较低，因此 AS 男性仍需进行 SB。
患者总结
本研究表明，对于参加前列腺癌主动监测计划的男性，单独进行基于影像的前列腺活检可能没有信息价值。
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