Department of Urology, Saint Jean Languedoc/La Croix du Sud Hospital, 20, route de Revel, 31400, Toulouse, France.
IUCT-O, Avenue Joliot-Curie, 31000, Toulouse, France.
World J Urol. 2019 Feb;37(2):243-251. doi: 10.1007/s00345-018-2399-z. Epub 2018 Jul 2.
The diagnostic strategy implementing multiparametric magnet resonance tomography (mpMRI) and targeted biopsies (TB) improves the detection and characterization of significant prostate cancer (PCa). We aimed to assess the clinical usefulness of systematic biopsies (SB) in the setting of patients having a pre-biopsy positive MRI.
A review of the literature was performed in March 2018. All studies investigating the performance of SB in addition to TB (all techniques) were assessed, both in the biopsy-naïve and repeat biopsy setting.
Evidence demonstrates that TB improves the detection of index-significant PCa compared with SB alone, in both initial and repeat biopsy settings. However, the combination of both TB and SB improved the overall (around 30%) and significant (around 10%) PCa detection rates as compared with TB alone. Significant differences between both biopsy approaches exist regarding cancer location favoring SB for the far lateral sampling, and TB for the anterior zone. Main current pitfalls of pure TB strategy are the learning curve and experience required for mpMRI reading and biopsy targeting, as well as the precision assessment in TB techniques.
A pure TB strategy omitting SB leads to the risk of missing up to 15% of significant cancer, due to limitations of mpMRI performance/reading and of precision during lesion targeting. SB remain necessary, in addition to the TB, to obtain the most accurate assessment of the entire prostate gland in this sub-group of patients at risk of significant disease.
实施多参数磁共振成像（mpMRI）和靶向活检（TB）的诊断策略可提高对显著前列腺癌（PCa）的检测和特征描述能力。我们旨在评估在术前 MRI 阳性患者中，系统活检（SB）的临床应用价值。
我们于 2018 年 3 月进行了文献复习。评估了所有研究在活检初治和重复活检设置中，除了 TB（所有技术）之外，还对 SB 进行的研究，评估了其表现。
研究结果表明，TB 可提高指数显著 PCa 的检出率，与 SB 相比，无论是在初治还是重复活检中均如此。然而，TB 联合 SB 可提高整体（约 30%）和显著（约 10%）PCa 的检出率，与单独 TB 相比。两种活检方法在癌症位置方面存在显著差异，SB 有利于远外侧采样，TB 则有利于前区。纯 TB 策略的主要当前缺陷是 mpMRI 阅读和活检靶向所需的学习曲线和经验，以及 TB 技术的精准度评估。
由于 mpMRI 性能/阅读和病变靶向的精准度限制，纯 TB 策略可能会导致高达 15%的显著癌症漏诊。因此，除了 TB 之外，SB 仍然是必要的，以便在这个具有显著疾病风险的患者亚组中，对整个前列腺进行最准确的评估。
