Tu Xiang, Lin Tianhai, Cai Diming, Liu Zhenhua, Yang Lu, Wei Qiang
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China.
Minerva Urol Nefrol. 2020 Apr;72(2):144-151. doi: 10.23736/S0393-2249.20.03639-5. Epub 2020 Jan 29.
Prebiopsy multiparametric magnetic resonance imaging (mpMRI) has been increasingly utilized for patients of suspicious prostate cancer (PCa). However, the optimal core number and site for MRI-targeted biopsy have not been clearly elucidated.
A systematic search in Pubmed, Embase and Ovid up to June 2019 was conducted and we identified studies reporting detection details of every MRI-targeted core. The incremental diagnostic value of performing additional cores was pooled on per-lesion analysis. Our secondary outcome concentrated on detection accuracy for cores of different site within one lesion.
Five studies comprising 2291 patients were identified to elucidate the association between targeted core number and cancer detection rates. Adding the second core to the first one resulted in 19.8% (range: 13.6-26.7%) increase in the detection rate of clinically significant lesions, and adding the third one to the first two resulted in 11.5% (range: 7.8-14.3%) increase. The incremental value of adding the fourth or the fifth core was 6.0% (4.7%, 6.9%) and 4.1% respectively. Four studies arranging MRI-targeted biopsy of more than two cores in well-determined sequences indicated more positive cores with higher cancer grade through center of the lesions.
Increasing the number of samples per target from one to two, or two to three resulted in a nonnegligible incremental detection rate of clinically significant lesions, while obtaining more than 3 cores per target provided a diminished incremental value. And performing targeted cores accurately through center of the lesions may help improve diagnostic accuracy.
活检前多参数磁共振成像（mpMRI）已越来越多地应用于疑似前列腺癌（PCa）患者。然而，MRI靶向活检的最佳活检针数和取材部位尚未明确。
截至2019年6月，我们在PubMed、Embase和Ovid数据库进行了系统检索，确定了报告每次MRI靶向活检取材细节的研究。在每个病灶分析中汇总增加活检针数的增量诊断价值。我们的次要结果集中在一个病灶内不同部位活检针的检测准确性。
确定了五项包含2291例患者的研究，以阐明靶向活检针数与癌症检出率之间的关联。在第一针基础上增加第二针，临床显著病灶的检出率提高了19.8%（范围：13.6%-26.7%），在前两针基础上增加第三针，检出率提高了11.5%（范围：7.8%-14.3%）。增加第四针或第五针的增量价值分别为6.0%（4.7%，6.9%）和4.1%。四项研究按照明确的顺序对两针以上进行MRI靶向活检，结果显示通过病灶中心取材，更多的活检针出现更高癌症分级的阳性结果。
将每个靶点的取材针数从一针增加到两针，或从两针增加到三针，临床显著病灶的增量检出率不可忽视，而每个靶点获取超过3针的增量价值降低。通过病灶中心准确取材可能有助于提高诊断准确性。
