前列腺组织扫描作为一种在常规实践中进行靶向活检的方法的评估。
Evaluation of Prostate HistoScanning as a Method for Targeted Biopsy in Routine Practice.
机构信息
Research Institute of Uronephrology and Reproductive Human Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Department of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
出版信息
Eur Urol Focus. 2019 Mar;5(2):179-185. doi: 10.1016/j.euf.2017.07.001. Epub 2017 Jul 19.
BACKGROUND
Prostate HistoScanning (PHS) is a tissue characterization system used to enhance prostate cancer (PCa) detection via transrectal ultrasound imaging.
OBJECTIVE
To assess the impact of supplementing systematic transrectal biopsy with up to three PHS true targeting (TT) guided biopsies on the PCa detection rate and preclinical patient assessment.
DESIGN, SETTING, AND PARTICIPANTS: This was a prospective study involving a cohort of 611 consecutive patients referred for transrectal prostate biopsy following suspicion of PCa. PHS-TT guided cores were obtained from up to three PHS lesions of ≥0.5cm per prostate and only one core per single PHS lesion. Histological outcomes from a systematic extended 12-core biopsy (Bx) scheme and additional PHS-TT guided cores were compared.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Comparison of PHS results and histopathology was performed per sextant. The χ and Mann-Whitney test were used to assess differences. Statistical significance was set at p<0.05.
RESULTS AND LIMITATIONS
PHS showed lesions of ≥0.5cm in 312 out of the 611 patients recruited. In this group, Bx detected PCa in 59% (185/312) and PHS-TT in 87% (270/312; p<0.001). The detection rate was 25% (944/3744 cores) for Bx and 68% (387/573 cores) for PHS-TT (p<0.001). Preclinical assessment was significantly better when using PHS-TT: Bx found 18.6% (58/312) and 8.3% (26/312), while PHS-TT found 42.3% (132/312) and 20.8% (65/312) of Gleason 7 and 8 cases, respectively (p<0.001). PHS-TT attributed Gleason score 6 to fewer patients (23.4%, 73/312) than Bx did (32.4%, 101/312; p=0.0021).
CONCLUSIONS
Patients with a suspicion of PCa may benefit from addition of a few PHS-TT cores to the standard Bx workflow.
PATIENT SUMMARY
Targeted biopsies of the prostate are proving to be equivalent to or better than standard systematic random sampling in many studies. Our study results support supplementing the standard schematic transrectal ultrasound-guided biopsy with a few guided cores harvested using the ultrasound-based prostate HistoScanning true targeting approach in cases for which multiparametric magnetic resonance imaging is not available.
背景
前列腺 HistoScanning（PHS）是一种组织特征系统，用于通过经直肠超声成像增强前列腺癌（PCa）的检测。
目的
评估在系统经直肠活检中补充多达三次 PHS 真正靶向（TT）引导活检对 PCa 检出率和临床前患者评估的影响。
设计、设置和参与者：这是一项前瞻性研究，涉及 611 例连续疑似 PCa 患者接受经直肠前列腺活检。从每个前列腺的≥0.5cm 的 PHS 病变中获得多达三个 PHS-TT 引导核心，并且每个 PHS 病变仅获得一个核心。比较系统扩展的 12 核活检（Bx）方案和额外的 PHS-TT 引导核心的组织学结果。
测量和统计分析
按六区进行 PHS 结果和组织病理学比较。使用 χ 和曼-惠特尼检验评估差异。统计学意义设为 p<0.05。
结果和局限性
PHS 在招募的 611 例患者中的 312 例中显示出≥0.5cm 的病变。在这组中，Bx 检测到 PCa 的比例为 59%（185/312），而 PHS-TT 为 87%（270/312；p<0.001）。Bx 的检出率为 25%（944/3744 核），而 PHS-TT 的检出率为 68%（387/573 核）（p<0.001）。当使用 PHS-TT 时，临床前评估明显更好：Bx 发现 18.6%（58/312）和 8.3%（26/312），而 PHS-TT 发现 42.3%（132/312）和 20.8%（65/312）分别为 Gleason 7 和 8 病例（p<0.001）。PHS-TT 将 Gleason 评分 6 的病例归因于更少的患者（23.4%，73/312），而 Bx 将 Gleason 评分 6 的病例归因于更多的患者（32.4%，101/312；p=0.0021）。
结论
疑似 PCa 的患者可能受益于在标准 Bx 工作流程中增加少量 PHS-TT 核心。
患者总结
靶向前列腺活检在许多研究中已被证明与标准系统随机抽样等效或更好。我们的研究结果支持在没有多参数磁共振成像的情况下，在标准经直肠超声引导活检中补充少量基于超声的前列腺 HistoScanning 真正靶向方法采集的靶向活检核心。
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