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采用中心点定位法的机器人靶向 MRI-US 融合前列腺活检的前瞻性分析。

A prospective analysis of robotic targeted MRI-US fusion prostate biopsy using the centroid targeting approach.

机构信息

Department of Urology, Charing Cross Hospital, Imperial Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK.

Division of Surgery and Interventional Science, University College London, 21 University Street, London, WC1E 6AU, UK.

出版信息

J Robot Surg. 2020 Feb;14(1):69-74. doi: 10.1007/s11701-019-00929-y. Epub 2019 Feb 19.

Abstract

Robotic prostate biopsy is an emerging technology. Recent development of this tool has allowed the performance of a transperineal prostate biopsy allowing pre-programmed standardized biopsy schemes. Prospective data collection was undertaken in 86 consecutive men who underwent robotically assisted transperineal prostate biopsy. All underwent a multi-parametric MRI pre-biopsy with centroid targeting followed by systematic template prostate biopsy. For the purposes of this study, our definition of clinically significant prostate cancer (csPCa) is any Gleason score > 6. Mean (SD) age, median (IQR) PSA, and median (IQR) prostate volume were 64.24 (6.97) years, of 7.79 ng/ml (6.5) and 45.06 cc (28), respectively. Overall, 44 (51.2%) men were diagnosed with csPCa. csPCa was detected in the targeted biopsies alone in 35 (40.1%) men. The addition of the 12-zone template biopsy increased the yield of csPCa for another 9 (10.5%) men. Of these 9 men, the majority (7) harbored primary pattern 3 disease and only 1 was identified to have high-grade disease. Out of these 9 men, 7 of them had the identification of csPCa in the sector, where a target was contained within that zone. Robotic-assisted prostate biopsy in our study has demonstrated a high detection of csPCa when combined with limited near-field sampling. Our study suggests the use of more accurate biopsy schemes such as ring-targeting of lesions to mitigate against systematic and random mathematical errors. Adoption of this tool and biopsy strategy would potentially avoid the increased morbidity associated with whole gland systematic unguided biopsies.

摘要

机器人前列腺活检是一种新兴技术。该工具的最新发展使得经会阴前列腺活检成为可能,允许进行预先编程的标准化活检方案。在 86 名连续接受机器人辅助经会阴前列腺活检的男性中进行了前瞻性数据收集。所有患者均在活检前进行多参数 MRI 检查,采用中心点定位,随后进行系统模板前列腺活检。在本研究中,我们将临床上有意义的前列腺癌(csPCa)定义为任何 Gleason 评分>6。平均(标准差)年龄、中位数(IQR)PSA 和中位数(IQR)前列腺体积分别为 64.24(6.97)岁、7.79ng/ml(6.5)和 45.06cc(28)。总体而言,44 名(51.2%)男性被诊断为 csPCa。35 名(40.1%)男性仅在靶向活检中发现 csPCa。12 区模板活检的增加使另外 9 名(10.5%)男性的 csPCa 检出率增加。在这 9 名男性中,大多数(7 名)存在原发性 3 型疾病,只有 1 名被发现存在高级别疾病。在这 9 名男性中,有 7 名男性在包含该区域内靶标的扇区中发现了 csPCa。在我们的研究中,当与有限的近场采样相结合时,机器人辅助前列腺活检显示出高的 csPCa 检出率。我们的研究表明,使用更准确的活检方案,如对病变进行环状靶向,以减轻系统和随机数学误差。采用这种工具和活检策略可能会避免与全腺体系统引导活检相关的发病率增加。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b67a/7000504/82fe068ce653/11701_2019_929_Fig1_HTML.jpg

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