Zhang Qing, Wang Wei, Zhang Bing, Shi Jong, Fu Yao, Li Danyan, Guo Suhan, Zhang Shengjie, Huang Haifeng, Jiang Xuping, Zhou Weimin, Guo Hongqian
Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China.
Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China.
Int Urol Nephrol. 2017 Mar;49(3):439-448. doi: 10.1007/s11255-016-1484-8. Epub 2016 Dec 22.
To prospectively compare biopsy outcomes between free-hand transperineal mpMRI/TRUS fusion targeted biopsy (TB) and transperineal systematic biopsy (SB) in patients with first prostate biopsy.
In all, 224 consecutive patients with the suspicion of PCa were investigated. All patients were evaluated by 3.0-T mpMRI applying the ESUR criteria. All patients underwent free-hand transperineal mpMRI/TRUS fusion TB and additionally a transperineal SB. Pathological findings of TB, SB, and step-sectioned RP specimens were analyzed.
The median age of the patients was 69 (40-85) years, median PSA level was 10.05 (3.61-78.39) ng/mL, and median prostate volume was 45.5 (22-77) mL. Overall, the PCa detection rate was 50.45% (113/224). TB detected significantly more cancer [44.2% (99/224) vs. 34.8% (78/224); P = 0.001] and clinically significant PCa [75.75% (75/99) vs. 62.82% (49/78); P = 0.005] than SB. For the upgrading of Gleason score, 39.74% (31/78), more clinically significant PCa was detected by using additional TB than by SB alone. Conversely, 5.05% (5/99) more clinically significant PCa was found by SB in addition to that by TB. The location of 96.67% (58/60) and Gleason score of 60% (36/60) of TB-proven ITs were correctly identified, as corroborated by RP specimens. The median IT volume was 1.125 (0.21-19.87) ml on MRI and 1.41 (0.13-9.56) ml in RP specimens.
Free-hand transperineal mpMRI/TRUS fusion biopsy was associated with a higher detection rate of clinically significant PCa while taking fewer cores. Moreover, this technique can reliably predict the location, and relatively reliably predict cancer volume and Gleason score of ITs.
前瞻性比较初次前列腺活检患者中徒手经会阴磁共振成像/经直肠超声融合靶向活检（TB）与经会阴系统活检（SB）的活检结果。
共对224例疑似前列腺癌的连续患者进行了研究。所有患者均采用欧洲泌尿生殖放射学会（ESUR）标准接受3.0-T磁共振成像评估。所有患者均接受徒手经会阴磁共振成像/经直肠超声融合TB，另外还接受了经会阴SB。对TB、SB以及根治性前列腺切除术（RP）标本连续切片的病理结果进行了分析。
患者的中位年龄为69（40 - 85）岁，中位前列腺特异性抗原（PSA）水平为10.05（3.61 - 78.39）ng/mL，中位前列腺体积为45.5（22 - 77）mL。总体而言，前列腺癌检测率为50.45%（113/224）。与SB相比，TB检测到的癌症显著更多[44.2%（99/224）对34.8%（78/224）；P = 0.001]，以及临床显著性前列腺癌更多[75.75%（75/99）对62.82%（49/78）；P = 0.005]。对于Gleason评分的升级，使用额外的TB比单独使用SB检测到多39.74%（31/78）的临床显著性前列腺癌。相反，SB在TB检测到的临床显著性前列腺癌基础上又多发现了5.05%（5/99）。经RP标本证实，TB确诊的前列腺内肿瘤（ITs）的位置96.67%（58/60）和Gleason评分60%（36/60）被正确识别。MRI上ITs的中位体积为1.125（0.21 - 19.87）ml，RP标本中为1.41（0.13 - 9.56）ml。
徒手经会阴磁共振成像/经直肠超声融合活检在获取较少组织芯的情况下，临床显著性前列腺癌的检测率更高。此外，该技术能够可靠地预测ITs的位置，并且相对可靠地预测其癌体积和Gleason评分。
