Dieffenbacher Svenja Christina, Popeneciu Ionel Valentin, Radtke Jan Philipp, Teber Dogu, Hohenfellner Markus, Hadaschik Boris Alexander, Hatiboglu Gencay
Department of Urology, University of Heidelberg, Heidelberg, Germany.
Urol Int. 2017;99(2):162-167. doi: 10.1159/000456078. Epub 2017 Feb 11.
To investigate the diagnostic accuracy of transperineal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy vs. transrectal prostate biopsy in transurethral resection (TUR) specimen of men undergoing TUR of the prostate (TURP) for symptomatic bladder outlet obstruction.
From a database of 3,509 men receiving prostate biopsy, all those undergoing TURP and negative prostate biopsy (n = 95; 45 transrectal, 50 transperineal fusion) were analysed. TURP specimens were compared with regard to incidental prostate cancer.
Pre- and peri-interventional parameters in transrectal vs. fusion biopsy groups for age (65.2 ± 7.8 vs. 65.5 ± 7.3 years; p = 0.84), prostate specific antigen (10.7 ± 8.5 vs. 10.9 ± 8.7 ng/mL; p = 0.93), preoperative prostate volume (72.5 ± 26.1 vs. 71.8 ± 28.1 mL; p = 0.91) and resected weight (43.7 ± 21.9 vs. 41.4 ± 20.7 g; p = 0.61) showed no significant differences. Analysing the TURP specimen, 5 incidental T1a prostate cancers were found (3 Gleason 3 + 3 = 6; 2 Gleason 3 + 4 = 7, all in the transrectal biopsy group). Although, more biopsy cores were obtained in the MRI/TRUS fusion biopsy group (26 cores [interquartile range, IQR 24-28] vs. 14 cores [IQR 12-24], p < 0.01), there was no statistical impact of the obtained number of cores (p = 0.9) on diagnostic accuracy. Statistical analyses revealed significantly better diagnostic accuracy favoring image-guided fusion biopsy (p = 0.02).
Our findings showed that a combination of MRI-targeted and systematic transperineal prostate biopsy improves patient safety. This is associated with a combination of transperineal biopsy technique and pre-interventional MRI.
探讨经会阴磁共振成像/经直肠超声（TRUS）融合前列腺活检与经直肠前列腺活检在因有症状的膀胱出口梗阻而接受经尿道前列腺电切术（TURP）的男性患者的经尿道前列腺电切（TUR）标本中的诊断准确性。
从3509例接受前列腺活检的男性数据库中，分析所有接受TURP且前列腺活检阴性的患者（n = 95；45例行经直肠活检，50例行经会阴融合活检）。比较TURP标本中的偶发前列腺癌情况。
经直肠活检组与融合活检组在术前及介入期间的参数，如年龄（65.2±7.8岁 vs. 65.5±7.3岁；p = 0.84）、前列腺特异性抗原（10.7±8.5 ng/mL vs. 10.9±8.7 ng/mL；p = 0.93）、术前前列腺体积（72.5±26.1 mL vs. 71.8±28.1 mL；p = 0.91）和切除重量（43.7±21.9 g vs. 41.4±20.7 g；p = 0.61），均无显著差异。分析TURP标本，发现5例偶发T1a期前列腺癌（3例Gleason 3 + 3 = 6；2例Gleason 3 + 4 = 7，均在经直肠活检组）。虽然MRI/TRUS融合活检组获取的活检芯更多（26个芯[四分位间距，IQR 24 - 28] vs. 14个芯[IQR 12 - 24]，p < 0.01），但获取的芯数对诊断准确性无统计学影响（p = 0.9）。统计分析显示，图像引导融合活检的诊断准确性显著更高（p = 0.02）。
我们的研究结果表明，MRI靶向与系统性经会阴前列腺活检相结合可提高患者安全性。这与经会阴活检技术和介入前MRI的结合有关。
