D'Agostino Daniele, Romagnoli Daniele, Giampaoli Marco, Bianchi Federico Mineo, Corsi Paolo, Del Rosso Alessandro, Schiavina Riccardo, Brunocilla Eugenio, Artibani Walter, Porreca Angelo
Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme.
Department of Urology, University of Bologna, Bologna, Italy.
Curr Urol. 2020 Mar;14(1):22-31. doi: 10.1159/000499264. Epub 2020 Mar 20.
Transrectal ultrasound-guided biopsy (TRUS-GB) is the current reference standard procedure for diagnosis of prostate cancer (PCa) but this procedure has limitations related to the low detection rate (DR) described in the literature. The aim of the study was to evaluate the DR efficiency, and complication rate in a pure "in-bore" magnetic resonance imaging-guided biopsy (MRI-GB) series according to the Prostate Imaging Reporting and Data System, version 2 (PI-RADS v2).
From July 2015 to April 2018, a series of 142 consecutive patients undergoing MRI-GB were prospectively enrolled. According to the European Society of Urogenital Radiology guidelines, the presence of clinically significant PCa (csPCa) on multiparametric magnetic resonance imaging was defined as equivocal, likely, or highly likely according to a PI-RADS v2, score of 3, 4, or 5, respectively.
Of 142 patients, 76 (53.5%) were biopsy naive and 66 (46.5%) had ≤ 1 previous negative set of random TRUS-GB findings. The MRI-GB findings were positive in 75 of 142 patients with a DR of 52.8%. Of the 76 patients with ≤ 1 previous set of TRUS-GB, 43 had PCa found by MRI-GB, with a DR of 57.3%. The DR in the 66 biopsy-naive patients was 48% (32/66). Of the 75 patients with positive biopsy findings, 54 (80.5%) were found to have csPCa on histological examination. Of these 54 patients, 28 had an International Society of Urological Pathology grade 2; 5 had grade 3, 19 had grade 4, and 2 had grade 5. Considering the anatomic distribution of the index lesions using the PI-RADS v2 scheme, the probability of PCa was greater for lesions located in the peripheral zone (55 of 75, 73.3%) than for those in the central zone (20 of 75, 26.7%).
Our study conducted on 142 patients confirmed the greater DR of csPCa by MRI-GB, with a very low number of cores needed and a negligible incidence of complications, especially in patients with a previous negative biopsy. MRI-GB is optimal for the diagnosis of anterior and central lesions.
经直肠超声引导下活检（TRUS-GB）是目前诊断前列腺癌（PCa）的参考标准程序，但该程序存在文献中所述的检测率（DR）较低的局限性。本研究的目的是根据前列腺影像报告和数据系统第2版（PI-RADS v2）评估单纯“孔内”磁共振成像引导下活检（MRI-GB）系列的DR效率和并发症发生率。
2015年7月至2018年4月，前瞻性纳入了连续142例行MRI-GB的患者。根据欧洲泌尿生殖放射学会指南，多参数磁共振成像上临床显著前列腺癌（csPCa）的存在根据PI-RADS v2评分分别定义为可疑、可能或高度可能，评分为3、4或5。
142例患者中，76例（53.5%）为初次活检，66例（46.5%）既往随机TRUS-GB检查结果≤1次为阴性。142例患者中75例MRI-GB检查结果为阳性，DR为52.8%。在既往TRUS-GB检查结果≤1次的76例患者中，43例通过MRI-GB发现患有PCa，DR为57.3%。66例初次活检患者的DR为48%（32/66）。在75例活检结果为阳性的患者中，54例（80.5%）经组织学检查发现患有csPCa。在这54例患者中，28例为国际泌尿病理学会2级；5例为3级，19例为4级，2例为5级。使用PI-RADS v2方案考虑索引病变的解剖分布，位于外周区的病变（75例中的55例，73.3%）发生PCa的可能性大于中央区的病变（75例中的20例，26.7%）。
我们对142例患者进行的研究证实，MRI-GB对csPCa的DR更高，所需活检针数非常少，并发症发生率可忽略不计，尤其是在既往活检结果为阴性的患者中。MRI-GB对于前部和中央病变的诊断是最佳的。
