联合磁共振成像/超声融合引导与系统活检在初次活检和既往活检患者前列腺中的应用。
Performance of Combined Magnetic Resonance Imaging/Ultrasound Fusion-guided and Systematic Biopsy of the Prostate in Biopsy-naïve Patients and Patients with Prior Biopsies.
机构信息
Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
出版信息
Eur Urol Focus. 2021 Jan;7(1):39-46. doi: 10.1016/j.euf.2019.06.015. Epub 2019 Jul 8.
BACKGROUND
As recent prospective studies showed targeted biopsies (TBs) to be superior to systematic biopsies (SBs), magnetic resonance imaging (MRI) is gaining wider acceptance in the diagnostic setup of prostate cancer (PCa).
OBJECTIVE
To examine the performance of MRI/ultrasound fusion-guided TB in combination with SB in the detection of PCa in patients with and without prior biopsy.
DESIGN, SETTING, AND PARTICIPANTS: A total of 219 men undergoing combined transrectal TB and 12-core SB from February 2014 to November 2018 were analysed. For all patients showing a suspicion of PCa in multiparametric MRI, TB was performed using fusion imaging with real-time virtual sonography.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Cancer detection rates (CDRs) and significant CDRs for TB, SB, and TB+SB were analysed. Further stratification was performed for a number of previous biopsy sessions and Prostate Imaging Reporting and Data System (PI-RADS) score. Significant PCa was defined as any PCa with Gleason score ≥3+4.
RESULTS AND LIMITATIONS
Of all, 141 patients were biopsy naïve, while 78 patients had at least one prior biopsy. Median prostate-specific antigen (PSA) level prior to biopsy was 8.4ng/ml (interquartile range 5.5-11.8ng/ml). The overall CDR was 63.5% (139/219), while the PI-RADS-dependent CDRs for the combination of TB+SB were 29.1%, 67.7%, and 86.2% for patients with PI-RADS 3, 4, and 5, respectively. Looking at TB or SB alone, CDRs were 55.7% and 57.5%. The overall CDR for significant PCa was 51.6%. (18.2%, 50.5%, and 81.5% for PI-RADS 3, 4, and 5, respectively). CDRs were significantly higher for biopsy-naïve patients (65.2% vs 67.4% vs 71.6% for TB vs SB vs TB+SB) than for patients with one previous negative biopsy (38.2% vs 43.6% vs 50.9% for TB vs SB vs TB+SB; all p<0.01).
CONCLUSIONS
Multiparametric MRI can raise the CDR in patients with and without biopsies performed earlier. With higher PI-RADS lesions, the risk of harbouring PCa increases. Combining TB with SB further improved the diagnostic accuracy in biopsy-naïve patients and after one previous negative biopsy.
PATIENT SUMMARY
Multiparametric magnetic resonance imaging before prostate biopsy increases cancer detection rates in biopsy-naïve patients and patients with a previous negative biopsy. The combination of targeted biopsy with systematic biopsy improved the diagnostic accuracy in biopsy-naïve patients and after one previous negative biopsy.
背景
最近的前瞻性研究表明，靶向活检（TB）优于系统活检（SB），因此磁共振成像（MRI）在前列腺癌（PCa）的诊断中得到了更广泛的认可。
目的
检查 MRI/超声融合引导 TB 联合 SB 在有和没有先前活检的患者中检测 PCa 的性能。
设计、地点和参与者：分析了 2014 年 2 月至 2018 年 11 月期间共 219 名接受经直肠 TB 和 12 核 SB 的男性。对于所有在多参数 MRI 中怀疑患有 PCa 的患者，均采用实时虚拟超声融合成像进行 TB。
结果和局限性
所有患者中，141 例为初次活检，78 例至少有一次先前活检。活检前中位前列腺特异性抗原（PSA）水平为 8.4ng/ml（四分位间距 5.5-11.8ng/ml）。总的 CDR 为 63.5%（139/219），而 TB+SB 组合的 PI-RADS 依赖性 CDR 分别为 PI-RADS 3、4 和 5 患者的 29.1%、67.7%和 86.2%。单独看 TB 或 SB，CDR 分别为 55.7%和 57.5%。显著 PCa 的总 CDR 为 51.6%。（PI-RADS 3、4 和 5 分别为 18.2%、50.5%和 81.5%）。对于初次活检的患者，CDR 明显高于有一次先前阴性活检的患者（TB 为 65.2%，SB 为 67.4%，TB+SB 为 71.6%；TB 为 38.2%，SB 为 43.6%，TB+SB 为 50.9%；均 p<0.01）。
结论
多参数 MRI 可提高先前有或无活检患者的 CDR。随着 PI-RADS 病变程度的增加，患 PCa 的风险增加。TB 联合 SB 可进一步提高初次活检和一次先前阴性活检患者的诊断准确性。
患者总结
前列腺活检前的多参数磁共振成像可提高初次活检和先前阴性活检患者的癌症检出率。TB 联合 SB 可提高初次活检和一次先前阴性活检患者的诊断准确性。
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