Freifeld Yuval, Xi Yin, Passoni Niccolo, Woldu Solomon, Hornberger Brad, Goldberg Kenneth, Bagrodia Aditya, Raj Ganesh, Margulis Vitaly, Cadeddu Jeffrey A, Lotan Yair, Francis Franto, Pedrosa Ivan, G Roehrborn Claus, Costa Daniel N
Department of Urology, UT Southwestern Medical Center, Dallas, TX.
Department of Radiology, UT Southwestern Medical Center, Dallas, TX.
Urol Oncol. 2019 Jan;37(1):57-62. doi: 10.1016/j.urolonc.2018.10.009. Epub 2018 Nov 13.
To determine the implications of different prostate sampling schemes on the diagnosis of clinically significant prostate cancer (csPCA, ISUP group 2-5) and clinically insignificant prostate cancer (ciPCA, ISUP group 1) in men with abnormal multiparametric magnetic resonance imaging (mpMRI) undergoing MRI-transrectal ulrasound fusion targeted biopsies.
This is a retrospective analysis of a cohort including all men who had a single lesion on mpMRI of the prostate performed between January 2016 and June 2017. All men underwent an MRI-transrectal ulrasound fusion biopsy and systematic (SBx) sampling of the prostate, which combined and were considered the standard of reference. The hypothetical 3 biopsy sampling schemes were defined as follows: Targeted biopsy only (TBx), TBx + ipsilateral SBx (ipsi-SBx) and TBx + contralateral SBx (contra-SBx) and were evaluated for the detection of csPCA and ciPCA. Sensitivity and 95% intervals were calculated, McNemar test was used to compare sensitivities between the various sampling schemes.
TBx + SBx detected csPCa in 47% (55 of 116) of the 116 men who met eligibility criteria. Sensitivity and 95% confidence intervals for csPCa detection was 85.5% (73.3%-93.5%), 96.4% (87.5%-99.6%), and 92.7 (82.4%-98%) for TBx alone, TBx + ipsi-SBx and TBx + contra-SBx, respectively. csPCa detection rates were higher for both TBx + ipsi-SBx and TBx + contra-SBx compared to TBx alone. Clinically insignificant cancers alone were detected in 7.7% (9 of 116), 10.3% (12 of 116), and 14.6% (17 of 116) of the cohort by TBx only and TBx + ipsi-SBx, and TBx + contra-SBx, respectively.
TBx + ipsi-SBx may increase the detection of csPCa while limiting overdiagnosis of indolent cancers.
确定不同前列腺采样方案对接受磁共振成像-经直肠超声融合靶向活检的多参数磁共振成像（mpMRI）异常男性中临床显著前列腺癌（csPCA，国际泌尿病理学会[ISUP]2-5组）和临床非显著前列腺癌（ciPCA，ISUP 1组）诊断的影响。
这是一项对队列的回顾性分析，队列包括2016年1月至2017年6月期间前列腺mpMRI有单一病灶的所有男性。所有男性均接受了磁共振成像-经直肠超声融合活检以及前列腺系统（SBx）采样，两者结合被视为参考标准。假设的三种活检采样方案定义如下：仅靶向活检（TBx）、TBx + 同侧SBx（ipsi-SBx）和TBx + 对侧SBx（contra-SBx），并对csPCA和ciPCA的检测进行评估。计算敏感性和95%区间，使用McNemar检验比较不同采样方案之间的敏感性。
在符合入选标准的116名男性中，TBx + SBx在47%（116人中的55人）检测到csPCa。仅TBx、TBx + ipsi-SBx和TBx + contra-SBx检测csPCa的敏感性及95%置信区间分别为85.5%（73.3%-93.5%）、96.4%（87.5%-99.6%）和92.7%（82.4%-98%）。与仅TBx相比，TBx + ipsi-SBx和TBx + contra-SBx的csPCa检测率均更高。仅TBx、TBx + ipsi-SBx和TBx + contra-SBx在队列中分别检测到7.7%（116人中的9人）、10.3%（116人中的12人）和14.6%（116人中的17人）的临床非显著癌。
TBx + ipsi-SBx可能增加csPCa的检测，同时限制惰性癌的过度诊断。
