Weill Cornell Medical College, New York, NY, USA.
Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, USA.
Eur Urol Oncol. 2020 Feb;3(1):10-20. doi: 10.1016/j.euo.2019.08.001. Epub 2019 Sep 4.
Multiparametric magnetic resonance imaging (mpMRI)-targeted transrectal prostate biopsy (TBx) may better predict pathology at radical prostatectomy than systematic transrectal prostate biopsy (SBx).
To assess concordance between biopsy and radical prostatectomy pathology in men undergoing a TBx as compared with those undergoing an SBx.
Four electronic databases (Ovid MEDLINE, Ovid EMBASE, the Cochrane Library [Wiley], and EBSCHOHost) were searched from inception until July 2018. Studies were included if they were published after 2012, conducted both SBx and TBx, and compared the biopsy results with final pathology after radical prostatectomy for ≥50 patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized. Bias was appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.
Our search yielded 10 studies including 1215 men. However, our inclusion criteria applied only to a proportion of men included in these studies. The median age was 65 yr and the median prostate-specific antigen level was 7.2 ng/ml. In the eight studies examining upgrading at prostatectomy, pathology from SBx was significantly more likely to be upgraded relative to TBx (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.48-4.14, p = 0.001). We found no significant difference in downgrading (OR 1.13, 95% CI 0.48-2.67, p = 0.783) between TBx and SBx. For both biopsy-naïve men and men with a prior negative biopsy, results from SBx were more likely to be upgraded than TBx at prostatectomy (OR 1.6 [95% CI 1.02-2.27, p < 0.001] and OR 4.23 [95% CI 1.68-8.48, p = 0.003], respectively).
Pathologic upgrading at prostatectomy was less likely with mpMRI-targeted biopsy versus systematic biopsy alone, without concurrent increase in downgrading. This increased accuracy should improve confidence in management decisions based on MRI-targeted biopsy pathology.
We reviewed the ability of multiparametric magnetic resonance imaging -targeted biopsy to predict cancer grade at radical prostatectomy. We found that targeted biopsy provides more accurate assessment of Gleason score at prostatectomy than systematic biopsy.
与系统经直肠前列腺活检（SBx）相比，多参数磁共振成像（mpMRI）靶向经直肠前列腺活检（TBx）可能更能预测前列腺根治性切除术的病理结果。
评估 TBx 与 SBx 相比，在接受前列腺活检的男性中与根治性前列腺切除术的病理结果的一致性。
从 2018 年 7 月开始，在四个电子数据库（Ovid MEDLINE、Ovid EMBASE、Cochrane 图书馆[Wiley]和 EBSCHOHost）中进行了搜索。如果研究发表于 2012 年之后，同时进行了 SBx 和 TBx，并对至少 50 名患者的根治性前列腺切除术后的活检结果与最终病理进行了比较，则纳入研究。使用了系统评价和荟萃分析的首选报告项目（PRISMA）指南。使用诊断准确性研究的质量评估-2（QUADAS-2）工具评估偏倚。
我们的搜索结果包括 10 项研究，共 1215 名男性。然而，我们的纳入标准仅适用于这些研究中纳入的一部分男性。中位年龄为 65 岁，中位前列腺特异性抗原水平为 7.2ng/ml。在八项研究中，对前列腺切除术的升级进行了检查，与 TBx 相比，SBx 的病理升级更有可能（优势比[OR]2.47，95%置信区间[CI]1.48-4.14，p=0.001）。我们发现 TBx 和 SBx 之间在降级（OR 1.13，95%CI 0.48-2.67，p=0.783）方面无显著差异。对于初次活检和初次活检阴性的男性，与 TBx 相比，SBx 在前列腺切除术后更有可能升级（OR 1.6[95%CI 1.02-2.27，p<0.001]和 OR 4.23[95%CI 1.68-8.48，p=0.003]）。
与单独的系统活检相比，mpMRI 靶向活检术发生前列腺切除术病理性升级的可能性较小，而降级的可能性没有增加。这种准确性的提高应该会提高基于 MRI 靶向活检病理的管理决策的信心。
我们回顾了多参数磁共振成像-靶向活检术预测前列腺根治性切除术时癌症分级的能力。我们发现，与系统活检相比，靶向活检术提供了更准确的前列腺切除术 Gleason 评分评估。
