Division of Urologic Oncology, Department of Urology, New York University Langone Health, New York, NY, USA.
Department of Population Health, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.
Eur Urol Oncol. 2018 Oct;1(5):418-425. doi: 10.1016/j.euo.2018.09.006. Epub 2018 Oct 5.
The number of prostate biopsy cores that need to be taken from each magnetic resonance imaging (MRI) region of interest (ROI) to optimize sampling while minimizing overdetection has not yet been clearly elucidated.
To characterize the incremental value of additional MRI-ultrasound (US) fusion targeted biopsy cores in defining the optimal number when planning biopsy and to predict men who might benefit from more than two targeted cores.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study of MRI-US fusion targeted biopsies between 2015 and 2017.
MRI-US fusion targeted biopsy in which four biopsy cores were directed to each MRI-targeted ROI.
The MRI-targeted cores representing the first highest Gleason core (FHGC) and first clinically significant cancer core (FCSC; GS≥3+4) were evaluated. We analyzed the frequency of FHGC and FCSC among cores 1-4 and created a logistic regression model to predict FHGC >2. The number of unnecessary cores avoided and the number of malignancies missed for each Gleason grade were calculated via clinical utility analysis. The level of agreement between biopsy and prostatectomy Gleason scores was evaluated using Cohen's κ.
A total of 479 patients underwent fusion targeted biopsy with four individual cores, with 615 ROIs biopsied. Among those, FHGC was core 1 in 477 (76.8%), core 2 in 69 (11.6%), core 3 in 48 (7.6%), and core 4 in 24 men (4.0%) with any cancer. Among men with clinically significant cancer, FCSC was core 1 in 191 (77.8%), core 2 in 26 (11.1%), core 3 in 17 (6.2%), and core 4 in 11 samples (4.9%). In comparison to men with a Prostate Imaging-Reporting and Data System (PI-RADS) score of 5, patients were significantly less likely to have FHGS >2 if they had PI-RADS 4 (odds ratio [OR] 0.287; p=0.006), PI-RADS 3 (OR 0.284; p=0.006), or PI-RADS 2 (OR 0.343; p=0.015). Study limitations include a single-institution experience and the retrospective nature.
Cores 1-2 represented FHGC 88.4% and FCSC 88.9% of the time. A PI-RADS score of 5 independently predicted FHGC >2. Although the majority of cancers in our study were appropriately characterized in the first two biopsy cores, there remains a proportion of men who would benefit from additional cores.
In men who undergo magnetic resonance imaging-ultrasound fusion targeted biopsy, the first two biopsy cores diagnose the majority of clinically significant cancers. However, there remains a proportion of men who would benefit from additional cores.
为了在最小化过度检测的同时优化采样，仍需明确指出从每个磁共振成像（MRI）感兴趣区域（ROI）中需要采集多少前列腺活检核心。
描述在计划活检时，额外的 MRI-超声（US）融合靶向活检核心的增量值，以确定最佳数量，并预测可能受益于超过两个靶向核心的男性。
设计、地点和参与者：这是一项 2015 年至 2017 年期间进行的 MRI-US 融合靶向活检的回顾性队列研究。
MRI-US 融合靶向活检，每个 MRI 靶向 ROI 定向采集四个活检核心。
共有 479 名患者接受了融合靶向活检，共采集了 479 个 ROI。其中，FHGC 为第 1 个核心（477 例，76.8%）、第 2 个核心（69 例，11.6%）、第 3 个核心（48 例，7.6%），第 4 个核心（24 例，4.0%）的活检标本中存在任何癌症。在有临床意义的癌症患者中，FCSC 为第 1 个核心（191 例，77.8%）、第 2 个核心（26 例，11.1%）、第 3 个核心（17 例，6.2%），第 4 个核心（11 例，4.9%）的活检标本中存在癌症。与前列腺成像报告和数据系统（PI-RADS）评分为 5 的患者相比，如果患者的 PI-RADS 评分为 4（比值比[OR]0.287；p=0.006）、PI-RADS 评分为 3（OR 0.284；p=0.006）或 PI-RADS 评分为 2（OR 0.343；p=0.015），则他们发生 FHGS>2 的可能性显著降低。
核心 1-2 代表 FHGC 和 FCSC 的 88.4%和 88.9%。PI-RADS 评分为 5 可独立预测 FHGS>2。尽管我们研究中的大多数癌症在前两个活检核心中得到了适当的描述，但仍有一部分男性需要额外的核心。
在接受 MRI-超声融合靶向活检的男性中，前两个活检核心可诊断出大多数有临床意义的癌症。然而，仍有一部分男性需要额外的核心。
