El-Shater Bosaily A, Valerio M, Hu Y, Freeman A, Jameson C, Brown L, Kaplan R, Hindley R G, Barratt D, Emberton M, Ahmed H U
Division of Surgery and Interventional Science, University College London, London, UK.
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
Prostate Cancer Prostatic Dis. 2016 Sep;19(3):258-63. doi: 10.1038/pcan.2016.7. Epub 2016 Jul 12.
The rationale for directing targeted biopsy towards the centre of lesions has been questioned in light of prostate cancer grade heterogeneity. In this study, we assess the assumption that the maximum cancer Gleason grade (Gleason grade hotspot) lies within the maximum dimension (volume hotspot) of a prostate cancer lesion.
3-D histopathological models were reconstructed using the outputs of the 5-mm transperineal mapping (TPM) biopsies used as the reference test in the pilot phase of Prostate Mri Imaging Study (PROMIS), a paired validating cohort study investigating the performance of multi-parametric magnetic resonance imaging (MRI) against transrectal ultrasound (TRUS) biopsies. The prostate was fully sampled with 5 mm intervals; each core was separately labelled, inked and orientated in space to register 3-D cancer lesions location. The data from the histopathology results were used to create a 3-D interpolated reconstruction of each lesion and identify the spatial coordinates of the largest dimension (volume hot spot) and highest Gleason grade (Gleason grade hotspot) and assess their concordance.
Ninety-four men, with median age 62 years (interquartile range, IQR= 58-68) and median PSA 6.5 ng ml(-1) (4.6-8.8), had a median of 80 (I69-89) cores each with a median of 4.5 positive cores (0-12). In the primary analysis, the prevalence of homogeneous lesions was 148 (76%; 95% confidence interval (CI) ±6.0%). In all, 184 (94±3.2%) lesions showed concordant hotspots and 11/47 (23±12.1%) of heterogeneous lesions showed discordant hotspots. The median 3-D distance between discordant hotspots was 12.8 mm (9.9-15.5). These figures remained stable on secondary analyses using alternative reconstructive assumptions. Limitations include a certain degree of error within reconstructed models.
Guiding one biopsy needle to the maximum cancer diameter would lead to correct Gleason grade attribution in 94% of all lesions and 79% of heterogeneous ones if a true hit was obtained. Further correlation of histological lesions, their MRI appearance and the detectability of these hotspots on MRI will be undertaken once PROMIS results are released.
鉴于前列腺癌分级的异质性，将靶向活检指向病变中心的基本原理受到质疑。在本研究中，我们评估了前列腺癌病变最大维度（体积热点）内存在最高癌症Gleason分级（Gleason分级热点）这一假设。
使用经会阴5毫米定位（TPM）活检的结果重建三维组织病理学模型，该活检在前列腺MRI成像研究（PROMIS）的试点阶段用作参考测试，PROMIS是一项配对验证队列研究，旨在研究多参数磁共振成像（MRI）相对于经直肠超声（TRUS）活检的性能。前列腺以5毫米间隔进行全采样；每个样本单独标记、染色并在空间中定向，以记录三维癌症病变的位置。组织病理学结果的数据用于创建每个病变的三维插值重建，并确定最大维度（体积热点）和最高Gleason分级（Gleason分级热点）的空间坐标，并评估它们的一致性。
94名男性，中位年龄62岁（四分位间距，IQR = 58 - 68），中位前列腺特异性抗原（PSA）为6.5 ng/ml（4.6 - 8.8），每人平均有80个（I69 - 89）样本，其中平均有4.5个阳性样本（0 - 12）。在初步分析中，均匀病变的患病率为148例（76%；95%置信区间（CI）±6.0%）。总共184例（94±3.2%）病变显示热点一致，11/47例（23±12.1%）异质性病变显示热点不一致。不一致热点之间的三维中位距离为12.8毫米（9.9 - 15.5）。在使用替代重建假设的二次分析中，这些数字保持稳定。局限性包括重建模型内存在一定程度的误差。
如果获得真正的命中，将一根活检针引导至最大癌症直径处，将在94%的所有病变和79%的异质性病变中导致正确的Gleason分级归因。一旦PROMIS结果公布，将进一步对组织学病变、其MRI表现以及这些热点在MRI上的可检测性进行相关性研究。
