系统前列腺活检仍然重要：不同适应证下 MRI/TRUS 融合靶向前列腺活检的综合分析。

Systematic prostate biopsy still matters: A comprehensive analysis of MRI/TRUS-fusion targeted prostate biopsies across different indications.

机构信息

Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.

Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, Zurich, Switzerland.

出版信息

Urol Oncol. 2019 Oct;37(10):678-687. doi: 10.1016/j.urolonc.2019.07.004. Epub 2019 Jul 31.

DOI:10.1016/j.urolonc.2019.07.004

PMID:31375340

Abstract

OBJECTIVES

To assess if a multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (TB) strategy is precise enough to replace systematic biopsies (SB) among men with different biopsy indications since an imaging-based pathway to guide indication and targeted prostate biopsy is currently under debate.

MATERIALS AND METHODS

Retrospective analysis was performed of 594 patients with one or more lesions according to Prostate Imaging and Reporting Data System (PI-RADS) receiving a consecutive TB and SB for one of the 3 indications: primary cancer suspicion (51.7%), persistent cancer suspicion after prior negative biopsy (35.4%), or control of a confirmed cancer (12.9%). Detection rates for overall cancer (CaP) and clinically significant cancer (csCaP, Gleason Score ≥3+4) were compared between TB and SB and to a combined approach for all patients and within the subgroups. Characteristics of cancers missed by one biopsy strategy were analyzed.

RESULTS

TB detected less CaP (302 vs. 366, P < 0.001) and csCaP (204 vs. 210 patients, P = 0.409) compared to SB except for men with prior negative biopsies (65 vs. 64 csCaP, P = 0.363). Cancer detection by TB or SB was independent of cancer localization and imaging characteristics. Combined TB and SB outperformed the single approaches for CaP and csCaP detection in each subgroup.

CONCLUSIONS

A single mpMRI and TB approach leads to a substantial number of missed CaP and csCaP across biopsies with different indications. Ongoing improvements of imaging, reading standardization, and biopsy techniques are required before replacing SB.

摘要

目的

评估多参数磁共振成像（mpMRI）靶向活检（TB）策略是否足够精确，可以替代具有不同活检指征的男性的系统活检（SB），因为目前正在争论基于影像学的方法来指导指征和靶向前列腺活检。

材料和方法

对 594 名根据前列腺成像和报告数据系统（PI-RADS）有一个或多个病灶的患者进行回顾性分析，这些患者接受了连续的 TB 和 SB，用于以下 3 种指征之一：原发性癌症怀疑（51.7%）、先前阴性活检后持续癌症怀疑（35.4%）或确诊癌症的控制（12.9%）。比较 TB 和 SB 与所有患者和亚组内的综合方法之间的总体癌症（CaP）和临床显著癌症（csCaP，Gleason 评分≥3+4）的检出率。分析一种活检策略遗漏的癌症的特征。

结果

与 SB 相比，TB 检测到的 CaP（302 例 vs. 366 例，P < 0.001）和 csCaP（204 例 vs. 210 例，P = 0.409）较少，除了先前有阴性活检的男性（65 例 vs. 64 例 csCaP，P = 0.363）。TB 或 SB 检测到的癌症与癌症定位和影像学特征无关。在每个亚组中，TB 和 SB 的联合应用均优于单一方法对 CaP 和 csCaP 的检测。