Department of Urology, Yale School of Medicine, New Haven, CT, USA.
Department of Urology, Yale School of Medicine, New Haven, CT, USA.
Eur Urol. 2019 Jul;76(1):14-17. doi: 10.1016/j.eururo.2019.04.008. Epub 2019 Apr 30.
The optimal method of magnetic resonance imaging (MRI)-ultrasound (US) fusion biopsy to adequately sample regions of interest (ROIs) remains unknown. We sought to determine the number and location of cores needed to adequately detect clinically significant prostate cancer (PCa). We identified patients undergoing MRI-US fusion prostate biopsy at our institution for known history or clinical suspicion of PCa. Multiparametric MRI studies were reviewed using Likert and Prostate Imaging Reporting and Data System (PI-RADS) v2 schema. Multiple targeted cores were taken from each ROI followed by 12-core systematic biopsy. In a distinct cohort of patients, lesions were targeted using a predetermined five-core template. We estimated cancers detected through sampling of five or fewer cores, assessed by core number and core location. We identified 744 patients with 581 lesions with PCa. Seventy-seven percent (279/361) of Gleason (G) ≥3+4 tumors and 72% (137/189) of G >3+4 tumors were detected on two-core sampling. Relative to all targeted cores, a two-core approach missed 16% of clinically significant cancers at first biopsy, 27% in prior negative, and 32% in active surveillance patients. Detection of G ≥3+4 cancers did not differ by core location. Sampling of two cores of ROIs misses nearly one-quarter of clinically significant PCa detected on additional sampling. PATIENT SUMMARY: We aimed to understand how the number of cores obtained from a suspicious area during prostate magnetic resonance imaging-ultrasound fusion biopsy affects cancer detection. We found that sampling of five cores missed substantially fewer cancers compared to two cores.
磁共振成像（MRI）-超声（US）融合活检以充分采样感兴趣区域（ROI）的最佳方法尚不清楚。我们旨在确定需要采集多少核心以及在何处采集核心，以充分检测临床显著前列腺癌（PCa）。我们确定了在我们的机构中接受 MRI-US 融合前列腺活检的患者，这些患者具有已知的 PCa 病史或临床可疑症状。使用 Likert 和前列腺成像报告和数据系统（PI-RADS）v2 方案对多参数 MRI 研究进行了回顾。从每个 ROI 采集多个靶向核心，然后进行 12 核系统活检。在另一组患者中，使用预定的五核模板靶向病变。我们估计通过采集五个或更少的核心检测到的癌症，并通过核心数量和核心位置进行评估。我们确定了 744 名患者的 581 个具有 PCa 的病变。77%（279/361）的 Gleason（G）≥3+4 肿瘤和 72%（137/189）的 G>3+4 肿瘤在两核取样中被检测到。与所有靶向核心相比，两核方法在初次活检中遗漏了 16%的临床显著癌症，在先前的阴性活检中遗漏了 27%，在主动监测患者中遗漏了 32%。G≥3+4 癌症的检测结果与核心位置无关。ROI 的两个核心的采样错过了近四分之一在进一步采样中检测到的临床显著的 PCa。患者总结：我们旨在了解从可疑区域采集的核心数量如何影响前列腺磁共振成像-超声融合活检中的癌症检测。我们发现，与两核相比，五核采样显著减少了癌症的漏诊。
