Steurer Stefan, Rico Sebastian Dwertmann, Simon Ronald, Minner Sarah, Tsourlakis Maria Christina, Krech Till, Koop Christina, Graefen Markus, Heinzer Hans, Adam Meike, Huland Hartwig, Schlomm Thorsten, Sauter Guido, Lumiani Agron
Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Martini-Clinic, Prostate Cancer Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
BJU Int. 2017 Sep;120(3):365-376. doi: 10.1111/bju.13840. Epub 2017 Apr 11.
To determine the utility of our transgluteal magnetic resonance imaging (MRI)-guided prostate biopsy approach.
A total of 960 biopsy series, taken within the period of 1 year, were evaluated, including 301 MRI-guided and 659 transrectal ultrasonography (TRUS)-guided biopsies.
The positivity rate and proportion of high grade cancers were significantly higher in MRI-guided than in TRUS-guided biopsies. Of 301 MRI-guided biopsies, 65.4% contained cancer while 57.2% of 659 TRUS biopsies contained cancer (P = 0.016). Gleason grade 3 + 3 = 6 disease was observed in 16.8% of 197 MRI-guided and in 36.1% of 377 TRUS-guided biopsies (P < 0.001). There was also a markedly higher quantity of cancer tissue in MRI-guided biopsies. In all cancers, the mean cancer surface area was 64.8 ± 51.6 mm in MRI-guided biopsies as compared with 23.0 ± 31.4 mm in non-MRI-guided biopsies (P < 0.001). With respect to the tissue quantity, superiority of MRI-guided biopsy was highest in Gleason grade 3 + 3 = 6 cancers (20.9 ± 27.9 vs 5.1 ± 10.2 mm ; P < 0.001) and in Gleason grade 3 + 4 = 7 cancers (59.7 ± 38.0 vs 17.7 ± 18.4 mm ; P < 0.001). Comparison of biopsy Gleason grades with findings in prostatectomy specimens was possible in 80 patients with MRI-guided and in 170 patients with non-MRI-guided biopsies. This comparison showed a very high but almost identical concordance of TRUS- and MRI-guided biopsies with the prostatectomy specimen findings. With both approaches, undetected high-risk cancers were present in ~10% of patients with low-risk biopsy results. A significant difference was observed, however, in the proportion of patients who had clinically insignificant cancers and who underwent surgery. The proportion of patients with Gleason grade 3 + 3 = 6 carcinoma in their prostatectomy specimen was 11.2% in the post-TRUS biopsy cohort, but only 2.5% in the post-MRI biopsy cohort (P = 0.021).
MRI-guided transgluteal prostate biopsy has a high detection rate for high-risk carcinomas, while the risk of detecting clinically insignificant carcinomas appears to be reduced. This may by itself lead to a reduction of unnecessary prostatectomies. Overtreatment may be further avoided by better applicability of molecular testing to MRI-guided biopsies because of the excessive amount of tissue available for analysis, especially in patients with potential low-risk carcinomas.
确定经臀磁共振成像（MRI）引导下前列腺穿刺活检方法的效用。
对1年内进行的960例活检系列进行评估，包括301例MRI引导下活检和659例经直肠超声（TRUS）引导下活检。
MRI引导下活检的阳性率和高级别癌症比例显著高于TRUS引导下活检。在301例MRI引导下活检中，65.4%含有癌症，而659例TRUS活检中有57.2%含有癌症（P = 0.016）。在197例MRI引导下活检中有16.8%观察到Gleason分级3 + 3 = 6的疾病，在377例TRUS引导下活检中有36.1%观察到（P < 0.001）。MRI引导下活检中癌组织数量也明显更多。在所有癌症中，MRI引导下活检的平均癌表面积为64.8±51.6平方毫米，而非MRI引导下活检为23.0±31.4平方毫米（P < 0.001）。就组织数量而言，MRI引导下活检的优势在Gleason分级3 + 3 = 6的癌症中最高（20.9±27.9对5.1±10.2平方毫米；P < 0.001）以及在Gleason分级3 + 4 = 7的癌症中（59.7±38.0对17.7±18.4平方毫米；P < 0.001）。对80例MRI引导下活检患者和170例非MRI引导下活检患者的活检Gleason分级与前列腺切除标本结果进行了比较。该比较显示TRUS和MRI引导下活检与前列腺切除标本结果的一致性非常高且几乎相同。两种方法中，活检结果为低风险的患者中约10%存在未被检测到的高风险癌症。然而，在患有临床意义不显著癌症且接受手术的患者比例上观察到显著差异。在TRUS活检后队列中，前列腺切除标本中Gleason分级3 + 3 = 6癌的患者比例为11.2%，但在MRI活检后队列中仅为2.5%（P = 0.021）。
MRI引导下经臀前列腺穿刺活检对高风险癌的检出率高，而检测临床意义不显著癌的风险似乎降低。这本身可能导致不必要前列腺切除术的减少。由于可用于分析的组织量过多，特别是在潜在低风险癌患者中，分子检测在MRI引导下活检中的更好应用可能进一步避免过度治疗。
