Department of Urology, Charité - University Medicine Berlin, Berlin, Germany.
Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany.
BJU Int. 2018 Aug;122(2):211-218. doi: 10.1111/bju.14212. Epub 2018 Apr 17.
To examine the performance of a primary magnetic resonance imaging (MRI)/ultrasonography (US) fusion-guided targeted biopsy (TB), and in combination with an added systematic biopsy (SB).
Analysis of 318 consecutive biopsy-naïve men with suspicious multiparametric MRI (mpMRI; Prostate Imaging Reporting and Data System [PI-RADS] score ≥3) undergoing transrectal TB and 10-core SB between January 2012 and December 2016. The indication for performing mpMRI was based on clinical parameters and decided by the treating urologist before admission. TB was performed with a sensor-based MRI/US fusion-guided platform. Clinically significant prostate cancer was defined as Gleason score ≥4 + 3 = 7 (International Society of Urological Pathology Grade [ISUP] grade 3) or maximum cancer core length of ≥6 mm.
A median (interquartile range) of 14 (13-14) biopsies per case were taken. The overall cancer detection rate (CDR) was 77% (245/318). The TB alone detected 67% of prostate cancers and the SB alone detected 70%. The PI-RADS dependent CDR for the combination of TB/SB were 38% (21/55), 78% (120/154) and 95% (104/109) for PI-RADS scores of 3/4/5, respectively. Clinically significant prostate cancer was diagnosed by the combination of TB and SB in 195 men (61%) and by TB alone in 163 cases (51%). The number of missed or underestimated prostate cancers with a Gleason score ≥8 for TB alone was 31 (10%, P < 0.001) and 21 (7%, P < 0.001) for SB alone in comparison with the results of the combination of TB and SB. The rate of insignificant prostate cancer was comparable for the combination of TB and SB and TB alone (50/318, 16% vs 50/318, 16%).
Pre-biopsy mpMRI is of incremental value in increasing the detection of clinically significant prostate cancer in biopsy-naïve patients with suspicion of prostate cancer. Combining TB with SB further improved the diagnostic accuracy without increasing the rate of insignificant prostate cancer.
探讨经直肠磁共振成像（MRI）/超声（US）融合引导靶向活检（TB），并与系统活检（SB）联合应用的性能。
对 2012 年 1 月至 2016 年 12 月期间，318 例经直肠 TB 和 10 核 SB 检查的疑似多参数 MRI（mpMRI；前列腺影像报告和数据系统 [PI-RADS]评分≥3）的活检初治男性患者进行分析。mpMRI 的适应证基于临床参数，由治疗泌尿科医生在入院前决定。TB 采用基于传感器的 MRI/US 融合引导平台进行。临床显著前列腺癌定义为 Gleason 评分≥4+3=7（国际泌尿病理学会分级 [ISUP]分级 3）或最大癌核长度≥6mm。
中位数（四分位数间距）为每例 14（13-14）个活检。总体癌症检出率（CDR）为 77%（245/318）。TB 单独检测到 67%的前列腺癌，SB 单独检测到 70%。PI-RADS 评分分别为 3/4/5 时，TB/SB 联合检测的 CDR 为 38%（21/55）、78%（120/154）和 95%（104/109）。TB 和 SB 联合检测诊断出 195 例（61%）临床显著前列腺癌，TB 单独检测诊断出 163 例（51%）。与 TB 和 SB 联合检测结果相比，TB 单独检测漏诊或低估 Gleason 评分≥8 的前列腺癌的数量为 31 例（10%，P<0.001），SB 单独检测为 21 例（7%，P<0.001）。TB 单独检测和 TB 和 SB 联合检测的非显著前列腺癌率相似（50/318，16%比 50/318，16%）。
经直肠 MRI 检查在疑似前列腺癌的活检初治患者中增加了临床显著前列腺癌的检出率，具有附加价值。TB 与 SB 联合应用可提高诊断准确性，而不增加非显著前列腺癌的发生率。
