MRI 靶向活检在前列腺癌检测中的应用：指南是否改变了我们的实践和前列腺癌检出率？
MRI-targeted biopsy for detecting prostate cancer: have the guidelines changed our practices and our prostate cancer detection rate?
机构信息
Department of Urology and Kidney Transplantation, APHM, Conception Academic Hospital, Aix-Marseille University, Marseille, France.
Department of Radiology and Medical Imaging, APHM, Conception Academic Hospital, Aix-Marseille University, Marseille, France.
出版信息
Int Urol Nephrol. 2020 Apr;52(4):611-618. doi: 10.1007/s11255-019-02353-5. Epub 2019 Nov 30.
PURPOSE
In our center, until 2018, MRI-targeted biopsy was underused. Since January 2018, we systematically performed MRI-targeted biopsy for suspicious PI-RADS ≥ 3 lesions in accordance to the recent guidelines. We hypothesized that the implementation of systematic prebiopsy MRI would increase the detection rate (DR) of prostate cancer (PCa) without increasing DR of clinically insignificant PCa (insignPCa).
PATIENTS AND METHODS
A retrospective study including consecutive men who underwent prostate biopsy for suspicion of PCa in our center between January 2017 and December 2018 was conducted. Combined biopsies were performed for suspicious MRI and systematic biopsies for nonsuspicious MRI. The primary outcome was to compare the DR of PCa per year. Secondary outcomes included DRs of clinically significant PCa (csPCa) and insignPCa between both years and outcomes of targeted vs systematic biopsies.
RESULTS
A total of 306 men (152 in 2017 and 154 in 2018) were included. Respectively, median (IQR) age was 69 (63-75) vs 70 (65-76) years (p = 0.29) and median (IQR) PSA density was 0.17 (0.13-0.28) vs 0.17 (0.11-0.26) (p = 0.24). There was a significant increase in prebiopsy MRI performed (120 [78.9%] vs 143 [92.8%]; p < 0.001) in 2018. DRs of PCa (94 [61.8%] vs 112 [72.7%]; p = 0.04) and csPCa (76 [50%] vs 95 [61.6%]; p = 0.04) increased in 2018, while the insignPCa DR was stable (p = 0.13). The DR of PCa was 58.3%, 65% and 71.2%, respectively, in targeted, systematic and combined biopsies (p = 0.02). In case of nonsuspicious MRI, the prevalence of csPCA was 12.5%.
CONCLUSIONS
Introducing systematical MRI-targeted biopsy in our clinical setting increased the PCa DR without overdiagnosing insignPCa. Implementation of prebiopsy MRI does not seem to avoid the need for systematic biopsy, and nonsuspicious MRI should not obviate the need for prostate biopsy when otherwise clinically indicated.
目的
在我们中心，直到 2018 年，磁共振成像（MRI）靶向活检的应用都较少。自 2018 年 1 月以来，我们根据最新指南，对可疑前列腺影像报告和数据系统（PI-RADS）评分≥3 的病变系统地进行了 MRI 靶向活检。我们假设实施系统的活检前 MRI 会提高前列腺癌（PCa）的检出率（DR），而不会增加临床意义不大的 PCa（insignPCa）的检出率。
患者和方法
我们对 2017 年 1 月至 2018 年 12 月在我们中心因怀疑 PCa 而接受前列腺活检的连续男性进行了一项回顾性研究。可疑 MRI 行联合活检，可疑 MRI 行系统活检。主要结局是比较每年 PCa 的检出率（DR）。次要结局包括两年间临床显著 PCa（csPCa）和 insignPCa 的检出率以及靶向与系统活检的结果。
结果
共纳入 306 名男性（2017 年 152 名，2018 年 154 名）。分别为中位（IQR）年龄为 69（63-75）岁 vs 70（65-76）岁（p=0.29）和中位（IQR）PSA 密度为 0.17（0.13-0.28）ng/ml vs 0.17（0.11-0.26）ng/ml（p=0.24）。2018 年活检前 MRI 检查的比例显著增加（120[78.9%] vs 143[92.8%]；p<0.001）。2018 年 PCa（94[61.8%] vs 112[72.7%]；p=0.04）和 csPCa（76[50%] vs 95[61.6%]；p=0.04）的检出率增加，而 insignPCa 的检出率保持稳定（p=0.13）。靶向、系统和联合活检的 PCa 检出率分别为 58.3%、65%和 71.2%（p=0.02）。在非可疑 MRI 的情况下，csPCA 的患病率为 12.5%。
结论
在我们的临床环境中引入系统的 MRI 靶向活检提高了 PCa 的检出率，而不会过度诊断 insignPCa。活检前 MRI 的应用似乎并没有避免系统活检的需要，当临床上需要时，非可疑 MRI 并不能避免前列腺活检的需要。
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