Gordetsky Jennifer B, Thomas John V, Nix Jeffrey W, Rais-Bahrami Soroush
Departments of *Pathology †Urology ‡Radiology, University of Alabama at Birmingham, Birmingham, AL.
Am J Surg Pathol. 2017 Jan;41(1):101-105. doi: 10.1097/PAS.0000000000000723.
Recent studies have suggested that multiparametric magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided prostate biopsy can detect more clinically significant prostate cancers, which could impact patient management. As many of the studies evaluating MRI/US fusion-guided prostate biopsy were conducted in specialized quaternary care centers, the question remains whether this technology is transferable to general practice. Our study assesses the diagnostic ability of MRI/US fusion-guided prostate biopsy compared with standard biopsy in the new era of prostate cancer Grade Grouping. We reviewed our prostate biopsy database evaluating men who underwent MRI/US fusion-guided prostate biopsy with concurrent standard 12-core extended-sextant biopsy. Patient demographics and pathologic findings were reviewed. All patient biopsies were performed by 1 of 2 urologic oncologists. Tumors were given a Grade Group for each biopsy based on the core with the highest grade in each case. A total of 191 patients underwent MRI/US fusion-guided biopsy with concurrent 12-core extended sextant biopsy, with a cancer detection rate of 56%. The average number of biopsy cores obtained via the targeted approach was significantly less than those obtained by standard biopsy, 4.8 cores versus 12 cores, respectively, P<0.001. There was no difference in cancer detection between targeted and standard biopsy, 41.4% and 49.2%, respectively, P=0.15. However, when comparing the 2 techniques, the degree of detection of ≥Grade Group 3 tumors significantly favored targeted biopsy over standard biopsy (P=0.009). MRI/US fusion-guided prostate biopsy is equivalent to the standard-of-care 12-core biopsy in terms of cancer detection and superior in detecting higher grade disease.
近期研究表明，多参数磁共振成像（MRI）/超声（US）融合引导下的前列腺穿刺活检能够检测出更多具有临床意义的前列腺癌，这可能会影响患者的治疗管理。由于许多评估MRI/US融合引导下前列腺穿刺活检的研究是在专业的四级医疗中心进行的，因此该技术能否应用于普通临床实践仍是个问题。我们的研究评估了在前列腺癌分级分组的新时代，MRI/US融合引导下前列腺穿刺活检与标准穿刺活检相比的诊断能力。我们回顾了前列腺穿刺活检数据库，该数据库纳入了接受MRI/US融合引导下前列腺穿刺活检并同时进行标准12针扩展六分区穿刺活检的男性患者。对患者的人口统计学资料和病理结果进行了回顾。所有患者的穿刺活检均由两位泌尿肿瘤学家中的一位进行。根据每例中最高分级的穿刺针芯，为每个穿刺活检的肿瘤给出一个分级组。共有191例患者接受了MRI/US融合引导下的穿刺活检并同时进行了12针扩展六分区穿刺活检，癌症检出率为56%。通过靶向穿刺获得的平均穿刺针芯数明显少于标准穿刺活检，分别为4.8针和12针，P<0.001。靶向穿刺活检与标准穿刺活检的癌症检出率无差异，分别为41.4%和49.2%，P=0.15。然而，在比较这两种技术时，≥3级组肿瘤的检出程度明显有利于靶向穿刺活检而非标准穿刺活检（P=0.009）。在癌症检测方面，MRI/US融合引导下的前列腺穿刺活检与标准的12针活检相当，在检测高级别疾病方面更具优势。
