Shoji Sunao, Hiraiwa Shinichiro, Ogawa Takahiro, Kawakami Masayoshi, Nakano Mayura, Hashida Kazunobu, Sato Yoshinobu, Hasebe Terumitsu, Uchida Toyoaki, Tajiri Takuma
Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
Department of Pathology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
Int J Urol. 2017 Apr;24(4):288-294. doi: 10.1111/iju.13306. Epub 2017 Feb 21.
To evaluate the accuracy of real-time elastic fusion image-guided transperineal prostate biopsy with needle tracking involving a mechanical position-encoded stepper in detecting clinically significant prostate cancer for biopsy-naïve men.
We prospectively recruited patients with serum prostate-specific antigen levels of 4.0-20 ng/mL and suspicious of prostate cancer on multiparametric magnetic resonance imaging. They underwent targeted biopsies for cancer-suspicious lesions and 12-core systematic biopsies. Pathological findings from biopsy cores and whole-mount specimens (for those who underwent radical prostatectomy) were analyzed.
A total of 250 patients were included, in whom targeted and systematic biopsies detected significant cancers in 55% and 25%, respectively (P < 0.001). The targeted biopsy cores (n = 527) showed significantly greater biopsy-proven significant cancer detection rates (P < 0.001), cancer core length (P < 0.0001), cancer core percentage (P < 0.001) and Gleason scores (P < 0.001) than did the systematic biopsies. The significant cancer detection rate for targeted lesions (those with Prostate Imaging and Reporting and Data System classification scores of 5) was 80%. Biopsy-proven significant cancer detection rates for targeted lesions ≤10 mm and >10 mm were similar for Prostate Imaging and Reporting and Data System scores of 4 (P = 0.707) and 5 (P = 0.386). In whole-mount specimens (n = 30), locations for 95% of significant cancers were diagnosed preoperatively. Targeted biopsies alone diagnosed 79% of significant cancers.
Although targeted biopsies are superior to systematic biopsies in detecting significant cancers, systematic biopsies maintain an important role in the diagnosis of prostate cancer in biopsy-naïve men.
评估采用机械位置编码步进器进行针跟踪的实时弹性融合图像引导经会阴前列腺活检在检测初诊前列腺癌患者临床显著性前列腺癌方面的准确性。
我们前瞻性招募了血清前列腺特异性抗原水平为4.0 - 20 ng/mL且多参数磁共振成像怀疑患有前列腺癌的患者。他们接受了针对可疑癌灶的靶向活检和12针系统活检。对活检组织芯及全层标本（接受根治性前列腺切除术的患者）的病理结果进行分析。
共纳入250例患者，其中靶向活检和系统活检分别检测出55%和25%的显著性癌症（P < 0.001）。与系统活检相比，靶向活检组织芯（n = 527）的活检证实显著性癌症检出率（P < 0.001）、癌组织芯长度（P < 0.0001）、癌组织芯百分比（P < 0.001）及 Gleason 评分（P < 0.001）均显著更高。靶向病灶（前列腺影像报告和数据系统分类评分为5分的病灶）的显著性癌症检出率为80%。对于前列腺影像报告和数据系统评分为4分（P = 0.707）和5分（P = 0.386）的≤10 mm和>10 mm的靶向病灶，活检证实的显著性癌症检出率相似。在全层标本（n = 30）中，95%的显著性癌症位置术前已被诊断。仅靶向活检诊断出79%的显著性癌症。
尽管靶向活检在检测显著性癌症方面优于系统活检，但系统活检在初诊前列腺癌患者的诊断中仍发挥着重要作用。
