基于表面投影的经会阴认知融合靶向前列腺活检：一种具有良好癌症检出率的原创技术。
Surface-projection-based transperineal cognitive fusion targeted biopsy of the prostate: an original technique with a good cancer detection rate.
机构信息
Department of urology, Peking University Shougang Hospital, Peking University Health Science Center, Beijing, 100144, China.
Peking University Wu Jieping Urology Center, Peking University Shougang Hospital, Peking University Health Science Center, 9# Jinyuanzhuang Road, Shijingshan district, Beijing, 100144, China.
出版信息
BMC Urol. 2019 Nov 4;19(1):107. doi: 10.1186/s12894-019-0535-8.
BACKGROUND
To report a new standardized cognitive fusion technique on transperineal targeted biopsy (TB) of prostate, and to evaluate its efficacy for cancer detection combined with systematic biopsy (SB) .
METHODS
We present a retrospective review of consecutive patients undergoing multiparametric magnetic resonance (mpMRI) imaging of the prostate with subsequent transperineal prostate biopsy from January 2016 to December 2018. A free-hand 12-core SB was performed for each patient. PI-RADS 3-5 lesions were further targeted for biopsy with our TB technique. Firstly, a central point of suspicious lesion (B') was registered cognitively on a transverse section of transrectal ultrasound (TRUS). Then, biopsy gun punctured vertically through a fixed pioneer site (A) on skin of perineum, and deep into the TRUS section to get A'. Next, targeted site (B), the surface-projection of B', would be determined on skin of perineum by A and distance from B' to A'. Finally, puncture through B to reach B'. Pathological findings of SB and TB were analyzed.
RESULTS
A total of 126 patients underwent transperineal prostate biopsy (47 SB only, 79 SB + TB). The age of the patients was 68.7 ± 9.2 years. The median preoperative PSA value was 11.8 ng/mL. Preoperative prostate volume was 60.5 ± 50.0 mL. The numbers of patients with PI-RADS scores of 1 through 5 were 4, 43, 27, 21 and 31, respectively. The overall detection rate of cancer was 61/126 (48.4%), and it was significantly higher in the combination cohort (56/79, 70.9%) compared with the SB only cohort (5/47, 10.6%, p<0.001). When focused on the combination cohort, TB detected a similar overall rate of PCa (53/79, 67.1% vs 52/79, 65.8%; p = 0.87) compared with SB. The clinically significant PCa (csPC) detection rate was 52/79 (65.8%), while for TB and SB the csPC/PC rate was 51/53 (96.2%) and 48/52 (92.3%), respectively(p = 0.44). TB demonstrated a better sampling performance (positive rate for each core) compared with SB (51.0% vs 31.3%, p < 0.001).
CONCLUSIONS
Surface-projection-based transperineal cognitive fusion targeted biopsy of the prostate has a good efficacy in detecting PCa.
背景
报告一种新的经会阴前列腺靶向活检（TB）的标准化认知融合技术，并评估其与系统活检（SB）相结合检测癌症的效果。
方法
我们回顾性分析了 2016 年 1 月至 2018 年 12 月期间接受多参数磁共振成像（mpMRI）检查并随后进行经会阴前列腺活检的连续患者。每位患者均进行了徒手 12 核 SB。PI-RADS 3-5 病变进一步采用我们的 TB 技术进行靶向活检。首先，在经直肠超声（TRUS）的横截面上，通过认知在可疑病变的中心点（B'）上进行标记。然后，活检枪通过会阴皮肤的固定先锋部位（A）垂直穿刺，并深入到 TRUS 截面以获得 A'。接下来，通过 A 和 B'到 A'的距离，确定会阴皮肤的靶向部位（B），即 B'的表面投影。最后，通过 B 进行穿刺以到达 B'。分析 SB 和 TB 的病理发现。
结果
共有 126 名患者接受了经会阴前列腺活检（47 例仅 SB，79 例 SB+TB）。患者年龄为 68.7±9.2 岁。术前 PSA 中位值为 11.8ng/mL。前列腺体积为 60.5±50.0mL。PI-RADS 评分 1 至 5 的患者人数分别为 4、43、27、21 和 31。癌症的总体检出率为 61/126（48.4%），在联合组（56/79，70.9%）明显高于仅 SB 组（5/47，10.6%，p<0.001）。当重点关注联合组时，TB 检测到 PCa 的总体检出率相似（53/79，67.1%与 52/79，65.8%；p=0.87）与 SB 相比。临床显著前列腺癌（csPC）检出率为 52/79（65.8%），而 TB 和 SB 的 csPC/PC 率分别为 51/53（96.2%）和 48/52（92.3%）（p=0.44）。TB 显示出比 SB 更好的采样效果（每核的阳性率）（51.0%比 31.3%，p<0.001）。
结论
基于表面投影的经会阴认知融合靶向前列腺活检在检测 PCa 方面具有良好的效果。
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