Department of Urology, Instituto Cirugía Urológica Avanzada (ICUA), Madrid, Spain.
J Urol. 2020 Oct;204(4):726-733. doi: 10.1097/JU.0000000000001083. Epub 2020 Apr 21.
We assessed the prostate cancer detection accuracy of transperineal prostate biopsy using multiparametric magnetic resonance imaging/ultrasound fusion targeted biopsy and micro-ultrasound during the same procedure. Micro-ultrasound is a new high-resolution imaging system that allows real-time targeted biopsy.
A total of 194 consecutive patients underwent transperineal prostate biopsies using real-time targeted micro-ultrasound (ExactVu™) and ultrasound fusion targeted biopsy (BiopSee®) in the same procedure, from February 2018 to September 2019. Biopsies were performed using a transperineal needle guide attached to the 29 MHz high-resolution micro-ultrasound transducer.
The overall positive rate was 56% (108) for prostate cancer and 42% (81) for clinically significant prostate cancer (Gleason Grade Group greater than 1), and adding micro-ultrasound and magnetic resonance imaging detected significantly more clinically significant prostate cancer than systematic biopsy (p <0.001). Micro-ultrasound found 12 of 108 (11%) prostate cancers that were missed by all other techniques and 11 (92%) were clinically significant prostate cancer. PI-RADS® and PRI-MUS™ (Prostate Risk Identification Using Micro-Ultrasound) were strong predictors of clinically significant prostate cancer in a logistic regression model (AUC 0.76). For prostate specific antigen greater than 4 ng/ml, PI-RADS greater than 3, there was an improvement in detection rate between PRI-MUS 4 and PRI-MUS 5 (52% Gleason Grade Group greater than 1 to 92% Gleason Grade Group greater than 1). No fever or clinical infection was observed and 17 (8.7%) patients presented with minor complications (Clavien Dindo I).
This is the first study using a transperineal approach for micro-ultrasound guided biopsy and multiparametric magnetic resonance imaging fusion biopsy. The results show a high accuracy for prostate cancer and clinically significant prostate cancer diagnosis, without infectious complications. The proposed method should be validated in large randomized clinical trials.
我们评估了经会阴前列腺活检中多参数磁共振成像/超声融合靶向活检和微超声在同一程序中的前列腺癌检测准确性。微超声是一种新的高分辨率成像系统，可实现实时靶向活检。
2018 年 2 月至 2019 年 9 月，共 194 例连续患者在同一程序中接受实时靶向微超声（ExactVu™）和超声融合靶向活检（BiopSee®）行经会阴前列腺活检。活检使用附在 29 MHz 高分辨率微超声换能器上的经会阴针引导器进行。
前列腺癌的总体阳性率为 56%（108 例），临床显著前列腺癌（Gleason 分级组大于 1）的阳性率为 42%（81 例），并且添加微超声和磁共振成像比系统活检检测到更多的临床显著前列腺癌（p <0.001）。微超声发现了 108 例前列腺癌中的 12 例（11%），这些癌症被所有其他技术都漏诊，其中 11 例（92%）为临床显著前列腺癌。PI-RADS®和 PRI-MUS™（使用微超声识别前列腺风险）是逻辑回归模型中临床显著前列腺癌的强预测因子（AUC 0.76）。对于前列腺特异性抗原大于 4ng/ml、PI-RADS 大于 3 的患者，PRI-MUS 4 与 PRI-MUS 5 之间的检测率有所提高（Gleason 分级组大于 1 的比例从 52%提高到 92%）。未观察到发热或临床感染，17 例（8.7%）患者出现轻微并发症（Clavien Dindo I）。
这是第一项使用经会阴入路进行微超声引导活检和多参数磁共振成像融合活检的研究。结果显示，该方法在诊断前列腺癌和临床显著前列腺癌方面具有较高的准确性，且无感染性并发症。该方法应在大规模随机临床试验中进一步验证。
