Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department of Medical Oncology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Cardiovasc Intervent Radiol. 2020 Jan;43(1):147-154. doi: 10.1007/s00270-019-02312-8. Epub 2019 Aug 23.
Precision medicine expands the treatment options for metastatic castration-resistant prostate cancer (mCRPC) by targeting druggable genetic aberrations. Aberrations can be identified following molecular analysis of metastatic tissue. Bone metastases, commonly present in mCRPC, hinder precision medicine due to a high proportion of biopsies with insufficient tumor cells for next-generation DNA sequencing. We aimed to investigate the feasibility of incorporating advanced target planning and needle guidance in bone biopsies and whether this procedure increases biopsy tumor yield and success rate of molecular analysis as compared to the current standards, utilizing only CT guidance.
In a pilot study, ten mCRPC patients received Ga-prostate-specific membrane antigen (PSMA)-PET/CT and diffusion-weighted MRI as biopsy planning images. These datasets were fused for targeting metastatic lesions with high tumor densities. Biopsies were performed under cone-beam CT (CBCT) guidance. Feasibility of target planning and needle guidance was assessed, and success of molecular analysis and tumor yield were reported.
Fusion target planning and CBCT needle guidance were feasible. Nine out of ten biopsies contained prostate cancer cells, with a median of 39% and 40% tumor cells by two different sequencing techniques. Molecular analysis was successful in eight of ten patients (80%). This exceeds previous reports on CT-guided biopsies that ranged from 33 to 44%. In two patients, important druggable aberrations were found.
A biopsy procedure using advanced target planning and needle guidance is feasible and can increase the success rate of molecular analysis in bone metastases, thereby having the potential of improving treatment outcome for patients with mCRPC.
Level 4, case series.
精准医学通过靶向可用药的基因异常扩大了转移性去势抵抗性前列腺癌（mCRPC）的治疗选择。异常可在对转移性组织进行分子分析后确定。骨转移是 mCRPC 常见的并发症，由于大量活检的肿瘤细胞不足以进行下一代 DNA 测序，因此阻碍了精准医学的发展。我们旨在研究在骨活检中纳入先进的靶向规划和针引导的可行性，以及与仅使用 CT 引导的当前标准相比，该程序是否会增加活检肿瘤产量和分子分析的成功率。
在一项试点研究中，10 名 mCRPC 患者接受了 Ga-前列腺特异性膜抗原（PSMA）-PET/CT 和弥散加权 MRI 作为活检规划图像。这些数据集被融合以靶向具有高肿瘤密度的转移性病变。在锥形束 CT（CBCT）引导下进行活检。评估了靶向规划和针引导的可行性，并报告了分子分析和肿瘤产量的成功率。
融合靶向规划和 CBCT 针引导是可行的。十次活检中有九次含有前列腺癌细胞，两种不同的测序技术检测到的中位数分别为 39%和 40%的肿瘤细胞。十种患者中有八种（80%）的分子分析成功。这超过了以前 CT 引导活检的报告范围，从 33%到 44%不等。在两名患者中发现了重要的可用药异常。
使用先进的靶向规划和针引导的活检程序是可行的，可以提高骨转移中分子分析的成功率，从而有可能改善 mCRPC 患者的治疗结果。
4 级，病例系列。
