Boesen Lars
a Department of Urology and Urological Research , Herlev Gentofte University Hospital , Herlev , Denmark.
Scand J Urol. 2019 Apr-Jun;53(2-3):89-96. doi: 10.1080/21681805.2019.1600581. Epub 2019 Apr 22.
The use of multiparametric magnetic resonance imaging (mpMRI) in prostate cancer (PCa) diagnosis is rapidly evolving to try to overcome the limitations of the current diagnostic pathway using systematic transrectal ultrasound-guided biopsies (TRUS) for all men with clinical suspicion of PCa. Prostate mpMRI allows for high quality lesion detection and characterization and has been shown to improve detection of significant PCa with a more accurate Gleason score grading. Suspicious lesions can be stratified by suspicion and sampled by selective MRI-guided targeted biopsies (TBx) for improved diagnostic accuracy. Several TBx methods have been established and include MRI/TRUS image fusion biopsies (cognitive or software-assisted) and in-bore biopsies, but none have yet proven superior in clinical practice. However, while MRI in-bore biopsy is not routinely used due to its costs and limited availability, MRI/TRUS image fusion is rapidly embraced as it allows skilled urologists to perform TBx in an outpatient clinic. Furthermore, it gives the operator the advantage of adding TBx to the systematic standard biopsy scheme, which is the currently recommended approach. With the anticipated increased future use of prebiopsy mpMRI, a more widespread implementation of MRI/TRUS image fusion platforms is concurrently expected in clinical practice. Therefore, the objective of this review is to assess the current status, challenges and future perspectives of prostate MRI/TRUS image fusion biopsies.
多参数磁共振成像（mpMRI）在前列腺癌（PCa）诊断中的应用正在迅速发展，旨在克服当前诊断途径的局限性，即对所有临床怀疑患有PCa的男性采用经直肠超声引导下的系统活检（TRUS）。前列腺mpMRI能够实现高质量的病变检测和特征描述，并且已证明可通过更准确的Gleason评分分级来提高对显著PCa的检测率。可疑病变可根据可疑程度进行分层，并通过选择性MRI引导下的靶向活检（TBx）进行采样，以提高诊断准确性。目前已建立了多种TBx方法，包括MRI/TRUS图像融合活检（认知或软件辅助）和腔内活检，但在临床实践中尚未证明哪种方法具有优越性。然而，由于腔内活检成本高且可用性有限，目前尚未常规使用，而MRI/TRUS图像融合活检因能让熟练的泌尿科医生在门诊进行TBx而迅速得到应用。此外，它还使操作人员能够在系统标准活检方案中增加TBx，这是目前推荐的方法。随着活检前mpMRI未来使用量的预期增加，临床实践中同时预计MRI/TRUS图像融合平台将得到更广泛的应用。因此，本综述的目的是评估前列腺MRI/TRUS图像融合活检的现状、挑战和未来前景。
