Lian Huibo, Zhuang Junlong, Wang Wei, Zhang Bing, Shi Jiong, Li Danyan, Fu Yao, Jiang Xuping, Zhou Weimin, Guo Hongqian
Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
Institute of Urology, Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China.
BMC Urol. 2017 Jul 5;17(1):52. doi: 10.1186/s12894-017-0241-3.
To evaluate the role of free-hand transperineal targeted prostate biopsy using multiparametric magnetic resonance imaging-transrectal ultrasound (mpMRI-TRUS) fusion in Chinese men with repeated biopsy.
A total of 101 consecutive patients suspicious of prostate cancer (PCa) at the mpMRI scan and with prior negative biopsy and elevated PSA values were prospectively recruited at two urological centers. Suspicious areas on mpMRI were defined and graded using PI-RADS score. Targeted biopsies (TB) were performed for each suspicious lesion and followed a 12-core systematic biopsy (SB). Results of biopsy pathology and whole-gland pathology at prostatectomy were analyzed and compared between TB and SB. The risk for biopsy positivity was assessed by univariate and multivariate logistic regression analysis.
Fusion biopsy revealed PCa in 41 of 101 men (40.6%) and 25 (24.8%) were clinically significant. There was exact agreement between TB and SB in 74 (73.3%) men. TB diagnosed 36% more significant cancer than SB (22 vs 13 cases, P = 0.012). When TB were combined with SB, an additional 14 cases (34.1%) of mostly significant PCa (71.4%) were diagnosed (P = 0.036). TB had greater sensitivity and accuracy for significant cancer than SB in 26 men with whole-gland pathology after prostatectomy. PI-RADS score on mpMRI was the most powerful predictor of PCa and significant cancer.
Free-hand transperineal TB guided with MRI-TRUS fusion imaging improves detection of clinical significant PCa in Chinese men with previously negative biopsy. PI-RADS score is a reliable predictor of PCa and significant cancer.
评估在接受重复活检的中国男性中，徒手经会阴靶向前列腺活检联合多参数磁共振成像-经直肠超声（mpMRI-TRUS）融合技术的作用。
在两个泌尿外科中心前瞻性招募了101例连续的患者，这些患者在mpMRI扫描中怀疑患有前列腺癌（PCa），既往活检结果为阴性且前列腺特异性抗原（PSA）值升高。使用前列腺影像报告和数据系统（PI-RADS）评分对mpMRI上的可疑区域进行定义和分级。对每个可疑病变进行靶向活检（TB），并在其后进行12针系统活检（SB）。分析并比较TB和SB的活检病理结果及前列腺切除术后的全腺病理结果。通过单因素和多因素逻辑回归分析评估活检阳性的风险。
融合活检在101名男性中发现41例（40.6%）患有PCa，其中25例（24.8%）具有临床意义。74名男性（73.3%）的TB和SB结果完全一致。TB诊断出的具有临床意义的癌症比SB多36%（22例对13例，P = 0.012）。当TB与SB联合使用时，又诊断出14例（34.1%）主要为具有临床意义的PCa（71.4%）（P = 0.036）。在26例前列腺切除术后有全腺病理结果的男性中，TB对具有临床意义癌症的敏感性和准确性高于SB。mpMRI上的PI-RADS评分是PCa和具有临床意义癌症的最强预测指标。
MRI-TRUS融合成像引导下的徒手经会阴TB可提高既往活检阴性的中国男性中临床意义PCa的检出率。PI-RADS评分是PCa和具有临床意义癌症的可靠预测指标。
