Barbas Bernardos G, Herranz Amo F, de Miguel Campos E, Luis Cardo A, Herranz Arriero A, Cancho Gil M J, Caño Velasco J, Jara Rascón J, Mayor de Castro J, Hernández Fernández C
Servicio de Urología, Hospital General Universitario Gregorio Marañón. Facultad de Medicina, Universidad Complutense (UCM), Madrid, España.
Servicio de Urología, Hospital General Universitario Gregorio Marañón. Facultad de Medicina, Universidad Complutense (UCM), Madrid, España.
Actas Urol Esp (Engl Ed). 2019 Jun;43(5):228-233. doi: 10.1016/j.acuro.2018.06.010. Epub 2019 Mar 1.
The aim of this study is to compare performance of two biopsy approaches in patients with at least one previous negative prostate biopsy (PB): classical transrectal biopsy (ClTB) versus cognitive registration biopsy (COG-TB).
A retrospective study of 205 patients with at least one negative PB. 144 (70.2%) patients underwent a prior mpMRI and 61 (29.8%) patients did not. Nodule classification was carried out according PI-RADS version 2. Peripheral zone (PZ) grouped pZa, pZpl and pZpm areas, transition zone (TZ) Tza, Tzp and Cz areas, and anterior zone (AZ) AS areas. COG-TB was conducted in patients with previous mpMRI (144); while in the remaining 61 (29.8%) patients a ClTB of PZ and TZ was performed. Statistical analysis was performed using Chi square and T-student tests for qualitative and quantitative variables, respectively. Multivariate analysis was carried out in order to identify predictive variables of prostate cancer.
Median patient age was 68 (IQR 62-72) years, median PSA was 8.3 (IQR 6.2-11.7) ng/ml and median previous biopsies was 1 (IQR 1-2). Digital rectal examinations (DRE) findings were normal in 169 (82.4%) patients and suspicious in 36 (17.6%) patients (cT2a-b in 34 patients and cT2c in 2). Median prostate volume was 48 (IQR 38-65) cc. Statistically significant differences in PSAD between both groups were found (P=.03). Transrectal ultrasound (TRUS) showed hypoechoic nodules in 8 (13.1%) ClTB patients and in 62 (43.1%) COG-TB patients (P=.0001). The median number of biopsy cylinders per set of prostate biopsies was 10 (IQR 10-10) in ClTB group and 11 (IQR 9-13) in COG-TB group (P=.75). Cancer was diagnosed in 74 (36.1%) patients: of them, 10 (16.4%) were ClTB patients and 64 (44.4%) COG-TB (P=.0001). Tumors classification was as follow: ISUP-1: 34 (45.9%), ISUP-2: 21 (28.4%), ISUP-3: 9 (12.2%), ISUP-4: 7 (9.5%) and ISUP-5: 3 (4.1%). No significant statistical differences were found (P=.89). The median number of biopsy cylinders impaired per set of prostate biopsies was 1 (IQR 1-5) in ClTB group and 2 (IQR 1-4) in COG-TB group (P=.93). Regarding independent predictive variables for prostate cancer the results were: age (OR=12.05; P=.049), suspicious DRE (OR=2.64; P=.04), hypoechoic nodule (OR=2.20; P=.03) and mpMRI +COG-TB sequence (OR=3.49; P=.003).
In patients with at least one negative PB, mpMRI +COG-TB sequence improves 3.5 (OR=3.49) times the diagnosis prostate vs. ClTB.
本研究的目的是比较两种活检方法在至少有一次先前前列腺活检（PB）结果为阴性的患者中的表现：传统经直肠活检（ClTB）与认知配准活检（COG-TB）。
对205例至少有一次PB结果为阴性的患者进行回顾性研究。144例（70.2%）患者此前接受过mpMRI检查，61例（29.8%）患者未接受过。根据PI-RADS第2版进行结节分类。外周区（PZ）包括pZa、pZpl和pZpm区域，移行区（TZ）包括Tza、Tzp和Cz区域，前区（AZ）包括AS区域。对先前接受过mpMRI检查的患者（144例）进行COG-TB；而对其余61例（29.8%）患者进行PZ和TZ的ClTB。分别使用卡方检验和t检验对定性和定量变量进行统计分析。进行多变量分析以确定前列腺癌的预测变量。
患者中位年龄为68岁（四分位间距62 - 72岁），中位前列腺特异抗原（PSA）为8.3 ng/ml（四分位间距6.2 - 11.7 ng/ml），先前活检的中位次数为1次（四分位间距1 - 2次）。169例（82.4%）患者的直肠指检（DRE）结果正常，36例（17.6%）患者可疑（34例为cT2a - b期，2例为cT2c期）。前列腺中位体积为48 cc（四分位间距38 - 65 cc）。两组间前列腺特异抗原密度（PSAD）存在统计学显著差异（P = 0.03）。经直肠超声（TRUS）显示，8例（13.1%）ClTB患者和62例（43.1%）COG-TB患者有低回声结节（P = 0.0001）。ClTB组每组前列腺活检的活检针数中位数为10根（四分位间距10 - 10根），COG-TB组为11根（四分位间距9 - 13根）（P = 0.75）。74例（36.1%）患者被诊断为癌症：其中，10例（16.4%）为ClTB患者，64例（44.4%）为COG-TB患者（P = 0.0001）。肿瘤分类如下：国际泌尿病理学会（ISUP）1级：34例（45.9%），ISUP 2级：21例（28.4%），ISUP 3级：9例（12.2%），ISUP 4级：7例（9.5%），ISUP 5级：3例（4.1%）。未发现显著统计学差异（P = 0.89）。ClTB组每组前列腺活检受损的活检针数中位数为1根（四分位间距1 - 5根），COG-TB组为2根（四分位间距1 - 4根）（P = 0.93）。关于前列腺癌的独立预测变量，结果如下：年龄（比值比[OR]=12.05；P = 0.049）、可疑DRE（OR = 2.64；P = 0.04）、低回声结节（OR = 2.20；P = 0.03）和mpMRI + COG-TB序列（OR = 3.49；P = 0.003）。
在至少有一次PB结果为阴性的患者中，mpMRI + COG-TB序列诊断前列腺癌的能力是ClTB的3.5倍（OR = 3.49）。
