Lacetera Vito, Cervelli Bernardo, Cicetti Antonio, Gabrielloni Giuliana, Montesi Michele, Morcellini Roberto, Parri Gianni, Recanatini Emilio, Giglioni Gianluca, Galosi Andrea Benedetto, Beatrici Valerio
Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro.
Arch Ital Urol Androl. 2016 Dec 30;88(4):296-299. doi: 10.4081/aiua.2016.4.296.
The objective of this study is to present our initial experience with magnetic resonance imaging/ultrasound (MRI/US) fusion biopsy using the Koelis Trinity device after the first consecutive 59 patients.
59 consecutive patients with suspected prostate cancer (PCA) underwent prostate biopsy using Trinity Koelis® (Koelis, Grenoble, France). We divided the patients into 2 groups: patients with a previous negative mapping underwent to a MRI/US fusion re-biopsy (Group A); and biopsy-naïve patients who underwent to a first stereotactic 3-D mapping of the prostate (Group B). Group A (22 patients):mean age 64 years (CI 48-73), mean PSA = 7.7 ng/ml (CI 4.2- 9.9); mean prostate volume 55 ml(CI 45-82), Digital Rectal Examination (DRE) positive in 2/22, number of lesions detected by MRI 1.4, mean cores from each MRI target lesion 3 (CI 2-5), mean total cores 15 ( CI 12-19). Group B (37 patients): mean age 66 years (CI 49-77), mean PSA= 4.7 (3.2- 7.9); mean prostate volume 45 ml (33-67), DRE positive in 5/37, mean total cores 14 ( CI 10-16) Results: In Group A 10/22 patients were positive for PCA (overall detection rate of 45.5%): 6 PCA were detected by target biopsy and 4 cancer by random biopsy. Significant prostate cancer (defined as the presence of Gleason pattern 4) was detected in 4/10 patients (Significant PCA detection rate of 40%) and all significant PCA were detected by MRI target biopsy. All PCA detected by random biopsy had Gleason score 3 + 3 = 6. In Group B (biopsy naïve patients) 14/37 patients were positive for PCA (overall detection rate of 37.8%), Significant prostate cancer was detected in 5/14 patients (Significant PCA detection rate of 35,7%). No significant side effects were recorded.
Our overall detection rate was 45.5% and 37.8% in Group A (patients with previous negative biopsy and persistent suspicion of PCA) and in Group B (biopsy naïve patients) respectively; clinical significant PCA detection rate was respectively 40% and 35.7%. These results are similar to current literature and promising for the future. We believe that using platforms of co-registered MRI/US fusion biopsy can potentially improve risk stratification and reduces understaging, undergrading and the need for repeat biopsies in biopsy naïve patients (using a stereotactic first mapping) and in patients with previous negative biopsy and persistent suspicion of PCA ( using a second MRI/US fusion biopsy).
本研究的目的是介绍在连续59例患者之后，我们使用Koelis Trinity设备进行磁共振成像/超声（MRI/US）融合活检的初步经验。
59例疑似前列腺癌（PCA）的连续患者使用Trinity Koelis®（法国格勒诺布尔的Koelis公司）进行前列腺活检。我们将患者分为两组：既往穿刺活检结果为阴性的患者接受MRI/US融合再次活检（A组）；以及初次接受前列腺立体定向三维穿刺活检的患者（B组）。A组（22例患者）：平均年龄64岁（置信区间48 - 73岁），平均前列腺特异抗原（PSA）= 7.7 ng/ml（置信区间4.2 - 9.9）；平均前列腺体积55 ml（置信区间45 - 82），直肠指检（DRE）阳性2/22例，MRI检测到的病灶数1.4个，每个MRI目标病灶的平均活检针数3针（置信区间2 - 5），平均总活检针数15针（置信区间12 - 19）。B组（37例患者）：平均年龄66岁（置信区间49 - 77岁），平均PSA = 4.7（3.2 - 7.9）；平均前列腺体积45 ml（33 - 67），DRE阳性5/37例，平均总活检针数14针（置信区间10 - 16）。结果：A组22例患者中有10例PCA阳性（总体检出率为45.5%）：6例PCA通过靶向活检检测到，4例癌症通过随机活检检测到。4/10例患者检测到显著前列腺癌（定义为存在Gleason 4级）（显著PCA检出率为40%），所有显著PCA均通过MRI靶向活检检测到。通过随机活检检测到的所有PCA的Gleason评分为3 + 3 = 6。B组（初次穿刺活检患者）37例患者中有14例PCA阳性（总体检出率为37.8%），5/14例患者检测到显著前列腺癌（显著PCA检出率为35.7%）。未记录到明显的副作用。
我们在A组（既往穿刺活检阴性且仍怀疑PCA的患者）和B组（初次穿刺活检患者）中的总体检出率分别为45.5%和37.8%；临床显著PCA检出率分别为40%和35.7%。这些结果与当前文献相似，且对未来很有前景。我们认为，使用MRI/US融合活检的联合注册平台可能会改善风险分层，并减少初次穿刺活检患者（使用立体定向首次穿刺）以及既往穿刺活检阴性且仍怀疑PCA的患者（使用第二次MRI/US融合活检）的分期不足、分级不足以及重复活检的需求。
