Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Int J Urol. 2019 May;26(5):544-549. doi: 10.1111/iju.13924. Epub 2019 Feb 21.
To evaluate the impact of magnetic resonance imaging/transrectal ultrasound fusion-targeted prostate biopsy on the diagnosis of clinically significant prostate cancer using real-time three-dimensional ultrasound-based organ-tracking technology.
The present study was a retrospective review of 262 consecutive patients with prostate-specific antigen of 7.1 ng/mL (interquartile range 4.0-19.8). All patients received pre-biopsy magnetic resonance imaging and had a suspicious lesion for clinically significant prostate cancer. All patients underwent a combination of systematic biopsy (6 cores) and three-dimensional ultrasound-based magnetic resonance imaging/transrectal ultrasound fusion-targeted biopsy (2 cores). The positive rate of any cancer, positive rate of clinically significant prostate cancer, Gleason score and maximum cancer core length were compared between systematic biopsy versus magnetic resonance imaging/transrectal ultrasound fusion-targeted prostate biopsy.
Overall, the positive rate of any cancer per patient was 61% (160/262) in systematic biopsy versus 79% (207/262) in magnetic resonance imaging/transrectal ultrasound fusion-targeted biopsy (P < 0.0001); and that of clinically significant prostate cancer per patient was 46% (120/262) in systematic biopsy versus 70% (181/262) in magnetic resonance imaging/transrectal ultrasound fusion-targeted biopsy (P < 0.0001). The positive rate of any cancer per core was 21.7% (330/1523) in systematic biopsy versus 68.6% (406/592) in magnetic resonance imaging/transrectal ultrasound fusion-targeted biopsy (P < 0.0001), and that of clinically significant prostate cancer per core was 12.7% (193/1423) in systematic biopsy versus 60.3% (357/592) in magnetic resonance imaging/transrectal ultrasound fusion-targeted biopsy (P < 0.0001). Adding systematic biopsy leads to 13 more cancer cases (5%). The distribution of Gleason score (6/7/8/9/10) was 59/71/23/6/1 in systematic biopsy versus 48/105/36/15/2 in magnetic resonance imaging/transrectal ultrasound fusion-targeted biopsy (P = 0.005). The maximum cancer core length was 5 mm (0.5-16) in systematic biopsy versus 8 mm (1-19 mm) in magnetic resonance imaging/transrectal ultrasound fusion-targeted biopsy (P < 0.0001).
Three-dimensional ultrasound-based magnetic resonance imaging/transrectal ultrasound fusion-targeted biopsy seems to be associated with a higher detection rate of clinically significant prostate cancer, with fewer cores than systematic random biopsy. However, significant cancer can still be detected by the systematic technique only. A combination of systematic biopsy with the targeted biopsy technique would avoid the underdiagnosis of clinically significant prostate cancer.
使用实时三维超声器官跟踪技术评估磁共振成像/经直肠超声融合靶向前列腺活检对临床显著前列腺癌诊断的影响。
本研究为回顾性分析 262 例前列腺特异性抗原为 7.1ng/ml（四分位距 4.0-19.8）的连续患者。所有患者均行前列腺磁共振成像检查，且存在可疑的临床显著前列腺癌病灶。所有患者均接受系统活检（6 针）和基于三维超声的磁共振成像/经直肠超声融合靶向活检（2 针）联合治疗。比较系统活检与磁共振成像/经直肠超声融合靶向前列腺活检在任何癌症阳性率、临床显著前列腺癌阳性率、Gleason 评分和最大癌核心长度方面的差异。
总体而言，系统活检的每位患者的任何癌症阳性率为 61%（160/262），而磁共振成像/经直肠超声融合靶向活检为 79%（207/262）（P<0.0001）；每位患者的临床显著前列腺癌阳性率为 46%（120/262），而磁共振成像/经直肠超声融合靶向活检为 70%（181/262）（P<0.0001）。系统活检的每针任何癌症阳性率为 21.7%（330/1523），而磁共振成像/经直肠超声融合靶向活检为 68.6%（406/592）（P<0.0001）；临床显著前列腺癌的每针阳性率为 12.7%（193/1423），而磁共振成像/经直肠超声融合靶向活检为 60.3%（357/592）（P<0.0001）。增加系统活检可多检出 13 例癌症（5%）。Gleason 评分（6/7/8/9/10）分布为系统活检 59/71/23/6/1，磁共振成像/经直肠超声融合靶向活检为 48/105/36/15/2（P=0.005）。最大癌核心长度为系统活检 5mm（0.5-16），磁共振成像/经直肠超声融合靶向活检为 8mm（1-19mm）（P<0.0001）。
基于三维超声的磁共振成像/经直肠超声融合靶向活检似乎与更高的临床显著前列腺癌检出率相关，且其针数少于系统随机活检。然而，系统技术仍可检测到显著的癌症。系统活检与靶向活检技术的联合应用可避免临床显著前列腺癌的漏诊。
