Marra Giancarlo, Eldred-Evans David, Challacombe Ben, Van Hemelrijck Mieke, Polson Alexander, Pomplun Sabine, Foster Christopher S, Brown Christian, Cahill Declan, Gontero Paolo, Popert Rick, Muir Gordon
Department of Urology, King's College Hospital, London, UK.
Urol Int. 2017;99(2):168-176. doi: 10.1159/000471491. Epub 2017 Jul 29.
Background/Aims/Objectives: Our aim was to evaluate the accuracy of systematic transperineal sector mapping biopsy (TPSMB) in predicting Gleason score (GS) at radical prostatectomy (RP), to compare its accuracy with standard transrectal ultrasound-guided biopsies (TRUS) and to establish the clinical impact of discordance between biopsies and RP on subsequent surgical management.
Two hundred fifty-five patients from 2008 to 2013 who underwent RP following TPSMB (n = 204) or TRUS (n = 51), were included in this retrospective multi-institutional study. Concordance between biopsies and RPs GS was assessed both as percentages and with Cohen's Kappa coefficient. All mismatches between biopsies and RP were assessed for significance by 3 urologists using the Delphi method.
No differences were present among the groups. Concordance between biopsy and RP GS was 75.49% for TPSMB and 64.70% for TRUS. Kappa coefficient was 0.42 and 0.39 respectively. The Delphi method showed lower clinical impact of GS discordances for TPSMB with 7.8% of patients having significant change, thus being potentially more suitable for other treatment modalities, compared to TRUS (13.7%).
TPSMB had a higher accuracy for predicting the GS grade at RP showing superior GS concordance compared with standard TRUS. TPSMB provides an effective technique for systematic prostate biopsy to evaluate overall prostate cancer GS.
背景/目的/目标：我们的目的是评估系统性经会阴扇形定位活检（TPSMB）在预测根治性前列腺切除术（RP）时 Gleason 评分（GS）的准确性，将其准确性与标准经直肠超声引导活检（TRUS）进行比较，并确定活检与 RP 之间的不一致对后续手术管理的临床影响。
本回顾性多机构研究纳入了 2008 年至 2013 年间接受 TPSMB（n = 204）或 TRUS（n = 51）后行 RP 的 255 例患者。活检与 RP 的 GS 一致性通过百分比和 Cohen's Kappa 系数进行评估。3 名泌尿科医生使用德尔菲法评估活检与 RP 之间的所有不匹配情况的显著性。
各组之间无差异。TPSMB 的活检与 RP GS 一致性为 75.49%，TRUS 为 64.70%。Kappa 系数分别为 0.42 和 0.39。德尔菲法显示，TPSMB 的 GS 不一致的临床影响较低，7.8%的患者有显著变化，因此与 TRUS（13.7%）相比，可能更适合其他治疗方式。
TPSMB 在预测 RP 时的 GS 分级方面具有更高的准确性，与标准 TRUS 相比显示出更高的 GS 一致性。TPSMB 为系统性前列腺活检提供了一种有效的技术，以评估前列腺癌的总体 GS。
