MRI-TRUS 融合与系统活检检测前列腺癌率的变化：学习曲线的证据。
Changes in prostate cancer detection rate of MRI-TRUS fusion vs systematic biopsy over time: evidence of a learning curve.
机构信息
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
出版信息
Prostate Cancer Prostatic Dis. 2017 Dec;20(4):436-441. doi: 10.1038/pcan.2017.34. Epub 2017 Aug 1.
BACKGROUND
To determine the effect of urologist and radiologist learning curves and changes in MRI-TRUS fusion platform during 9 years of NCI's experience with multiparametric magnetic resonance imaging (mpMRI)/TRUS fusion biopsy.
METHODS
A prospectively maintained database of patients undergoing mpMRI followed by fusion biopsy (Fbx) and systematic biopsy (Sbx) from 2007 to 2016 was reviewed. The patients were stratified based on the timing of first biopsy. Cohort 1 (7/2007-12/2010) accounted for learning curve. Cohort 2 (1/2011-5/2013) and cohort 3 (5/2013-4/2016) included patients biopsied prior to and after debut of a new software platform, respectively. Clinically significant (CS) disease was defined as Gleason 7 (3+4) or higher. McNemar's test compared cancer detection rates (CDRs) of Sbx and Fbx between time periods.
RESULTS
1528 patients were included in the study with 230, 537 and 761 patients included in three respective cohorts. Median age (interquartile range) was 61.0 (±9.0), 62.0 (±7.3), and 64.0 (±11.0) years in three cohorts, respectively (P<0.001). Fbx and Sbx had comparable CS CDR in cohort 1 (24.8 vs 22.2%, P=0.377). Fbx detected significantly more CS disease compared to Sbx in the following two periods (cohort 2: 31.5 vs 25.0%, P=0.001; cohort 3: 36.4 vs 30.3%, P<0.001) and detected significantly less low risk disease in the same period (cohort 2: 14.5 vs 19.6%, P<0.001; cohort 3: 12.6 vs 16.7%, P<0.001). Even after multivariate adjustment with age, PSA, race, clinical stage and MRI suspicion score, Fbx CS cancer detection increased in successive cohorts (cohort 2: OR 2.23, P=0.043; cohort 3: OR 2.92, P=0.007).
CONCLUSIONS
In the past 9 years, there has been significant improvement in the accuracy of Fbx. Our results show that after an early learning period, Fbx detected higher rates of CS cancer and lower rates of clinically insignificant cancer than Sbx. Software advances allowed for even greater detection of CS disease.
背景
为了确定泌尿科医生和放射科医生在 NCI 进行多参数磁共振成像（mpMRI）/TRUS 融合活检 9 年期间的学习曲线和 MRI-TRUS 融合平台变化的影响。
方法
回顾了 2007 年至 2016 年期间接受 mpMRI 后行融合活检（Fbx）和系统活检（Sbx）的患者的前瞻性维护数据库。根据首次活检的时间对患者进行分层。队列 1（2007 年 7 月至 2010 年 12 月）代表学习曲线。队列 2（2011 年 1 月至 2013 年 5 月）和队列 3（2013 年 5 月至 2016 年 4 月）分别包括在新软件平台推出前和推出后接受活检的患者。临床显著（CS）疾病定义为 Gleason 7（3+4）或更高。McNemar 检验比较了不同时间段 Sbx 和 Fbx 的癌症检出率（CDR）。
结果
本研究共纳入 1528 例患者，分别有 230、537 和 761 例患者纳入三个相应队列。三个队列的中位年龄（四分位间距）分别为 61.0（±9.0）、62.0（±7.3）和 64.0（±11.0）岁（P<0.001）。在队列 1 中，Fbx 和 Sbx 的 CS CDR 具有可比性（24.8% vs 22.2%，P=0.377）。在随后的两个时期，Fbx 检测到的 CS 疾病明显多于 Sbx（队列 2：31.5% vs 25.0%，P=0.001；队列 3：36.4% vs 30.3%，P<0.001），而同一时期检测到的低风险疾病明显减少（队列 2：14.5% vs 19.6%，P<0.001；队列 3：12.6% vs 16.7%，P<0.001）。即使在年龄、PSA、种族、临床分期和 MRI 可疑评分的多变量调整后，Fbx 的 CS 癌症检出率在连续队列中仍有所增加（队列 2：OR 2.23，P=0.043；队列 3：OR 2.92，P=0.007）。
结论
在过去的 9 年中，Fbx 的准确性有了显著提高。我们的结果表明，在早期学习阶段之后，Fbx 检测到的 CS 癌症的比例更高，而临床意义不大的癌症的比例更低。软件的进步使得 CS 疾病的检测率更高。
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