Department of Urology, University of Alabama at Birmingham, Birmingham, AL, UK.
Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, UK.
Prostate Cancer Prostatic Dis. 2018 Nov;21(4):549-555. doi: 10.1038/s41391-018-0062-9. Epub 2018 Jul 9.
Magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy has improved the ability to localize and detect prostate cancer (PCa) with efficiency surpassing systematic biopsy. Nevertheless, some patients have PCa missed using the MRI-targeted biopsy sampling alone. We aim to identify clinical and imaging parameters associated with cases where targeted biopsy did not detect PCa compared to systematic biopsy.
We conducted a retrospective review of patients who underwent MRI/US fusion-guided biopsy in addition to concurrent systematic, extended-sextant biopsy between 2014 and 2017. For patients with PCa detected on systematic biopsy not properly localized by MRI/US fusion-guided biopsy, the sextant distance from MRI-targeted lesion to the cancer-positive sextant was calculated and parameters potentially predicting this targeting miss were evaluated.
In all, 35/127 (27.6%) patients with single-session MRI/US fusion-guided biopsy plus standard biopsy finding PCa had lesions incorrectly localized. Of these, 15/35 (42.9%) were identified as possible fusion-software misregistrations. The remainder, 12/35 (34.3%), represented targeted biopsies one sextant away from the cancer focus and 8/35 (22.9%) targeted biopsies two sextants away from the cancer focus. Only 7/35 (20.0%) patients were determined to have clinically significant PCa, which represents 7/127 (5.5%) of the overall population. Lower MRI lesion volumes (p = 0.022), lesion density (p < 0.001), and PI-RADS scores (p < 0.001) were significantly associated with targeted biopsy missing PCa detected on systematic biopsy.
Clinically significant PCa is rarely missed utilizing MRI/US fusion-guided biopsy. With the majority of missed tumors representing targeting misregistrations or cases of low-grade cancer in sextants immediately adjacent to MRI suspicious lesions. Lower MRI lesion volumes, lesion density, and PI-RADS are predictors of cases with targeted biopsies missing cancer, for which systematic sampling of the sextants containing MRI targets and adjacent sextants would most optimize PCa detection.
磁共振成像（MRI）/超声（US）融合引导活检提高了定位和检测前列腺癌（PCa）的能力，其效率超过了系统活检。然而，一些患者在单独使用 MRI 靶向活检采样时仍会遗漏 PCa。我们旨在确定与 MRI 靶向活检未能检测到 PCa 相关的临床和影像学参数，与系统活检相比。
我们对 2014 年至 2017 年间接受 MRI/US 融合引导活检以及同时进行的系统、扩展六分体活检的患者进行了回顾性分析。对于在系统活检中发现 PCa 但 MRI/US 融合引导活检未能正确定位的患者，计算 MRI 靶向病变与癌症阳性六分体之间的六分体距离，并评估可能预测这种靶向遗漏的参数。
在所有接受单次 MRI/US 融合引导活检加标准活检发现 PCa 的 127 例患者中，有 35 例（27.6%）病变定位不正确。其中，15 例（42.9%）为可能的融合软件配准错误。其余 12/35（34.3%）例靶向活检距离癌灶 1 个六分体，8/35（22.9%）例靶向活检距离癌灶 2 个六分体。只有 7/35（20.0%）例患者被确定为有临床意义的 PCa，占总人群的 7/127（5.5%）。MRI 病变体积较小（p=0.022）、病变密度较低（p<0.001）和 PI-RADS 评分较低（p<0.001）与系统活检中发现的靶向活检遗漏 PCa 显著相关。
利用 MRI/US 融合引导活检很少遗漏有临床意义的 PCa。大多数遗漏的肿瘤代表靶向配准错误或 MRI 可疑病变附近的六分体中低级别癌症病例。MRI 病变体积、病变密度和 PI-RADS 是靶向活检遗漏癌症的预测因素，对于包含 MRI 靶点和相邻六分体的系统采样，最能优化 PCa 的检测。
