MRI 靶向活检单独诊断而无伴随标准系统抽样的活检初筛男性行根治性前列腺切除术的病理发现。

Pathological findings at radical prostatectomy of biopsy naïve men diagnosed with MRI targeted biopsy alone without concomitant standard systematic sampling.

机构信息

Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Universita degli Studi di Milano, Milan, Italy.

Universita degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy; Precision Imaging and Research Unit- Department of Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology, IRCCS, Milan, Italy.

出版信息

Urol Oncol. 2020 Dec;38(12):929.e11-929.e19. doi: 10.1016/j.urolonc.2020.05.027. Epub 2020 Jun 26.

DOI:10.1016/j.urolonc.2020.05.027

PMID:32600928

Abstract

OBJECTIVES

To test international society of urological pathology grade group (ISUP GG) concordance rates between multiparametric magnetic resonance imaging (mpMRI) targeted biopsies (TB) vs. standard systematic biopsies (SB) and radical prostatectomy (RP) specimens, in biopsy naïve patients.

MATERIALS AND METHODS

This retrospective single center study included 80 vs. 500 biopsy naïve patients diagnosed with TB vs. SB and treated with RP between 2015 and 2018. First, we compared ISUP GG concordance rates and the percentages of undetected clinically significant prostate cancer (csPCa: ISUP GG  ≥ 3), between TB vs. SB and RP. Second, multivariable logistic regression models tested predictors of concordance rates before and after 1:3 propensity score (PS) matching. Third, among TB patients, univariable logistic regression models tested variables associated with ISUP GG concordance at RP.

RESULTS

Overall, ISUP GG concordance rates were, respectively, 55 vs. 41.4% for TB vs. SB (P = 0.02). However, no differences in concordance rates were observed in patients with biopsy ISUP GG1 (31 vs. 33.9% for TB vs. SB; P = 0.8). Moreover, 15 vs. 18.8% csPCa were missed by TB vs. SB, respectively (P = 0.4). In multivariable logistic regression models, TB were associated with higher concordance rates before (odds ratio [OR]: 1.13; P = 0.04) and after 1:3 PS matching (OR: 1.15; P 0.03), compared to SB. In TB patients, age (OR: 0.98; P = 0.04), maximum cancer core involvement (MCCI; OR: 1.02; P = 0.02) and maximum cancer core length (MCCL; OR: 1.01; P = 0.07) were associated with ISUP GG concordance. Moreover, a trend for lower concordance rates was observed with higher PSA-D (OR: 0.77; P = 0.1). Finally, intermediate lesion location at mpMRI was associated with lowest concordance rates (44%).

CONCLUSION

In biopsy naïve patients treated with RP, TB achieved higher rates of ISUP GG concordance, but same percentages of csPCa missed, compared to SB. Moreover, only patients with ISUP GG ≥2, but not patients with ISUP GG1, exhibited higher concordance rates. Finally, age, MCCI, MCCL, PSA-D, and lesion location were associated with concordance between TB and RP.

摘要

目的

在经多参数磁共振成像（mpMRI）靶向活检（TB）与标准系统活检（SB）和根治性前列腺切除术（RP）标本的比较中，检测国际泌尿病理学会（ISUP GG）分级组在初次活检的患者中的一致性率。

材料与方法

本回顾性单中心研究纳入了 80 例初次活检的 TB 患者和 500 例初次活检的 SB 患者，他们均接受了 RP 治疗，时间为 2015 年至 2018 年。首先，我们比较了 TB 与 SB 及 RP 之间的 ISUP GG 一致性率和未检出临床显著前列腺癌（csPCa：ISUP GG ≥3）的百分比。其次，多变量逻辑回归模型检测了 1:3 倾向评分（PS）匹配前后一致性率的预测因素。最后，在 TB 患者中，单变量逻辑回归模型检测了与 RP 时 ISUP GG 一致性相关的变量。

结果

总体而言，TB 与 SB 的 ISUP GG 一致性率分别为 55%和 41.4%（P=0.02）。然而，在活检 ISUP GG1 的患者中，TB 与 SB 的一致性率无差异（TB 与 SB 分别为 31%和 33.9%；P=0.8）。此外，TB 漏诊的 csPCa 分别为 15%和 18.8%（P=0.4）。在多变量逻辑回归模型中，与 SB 相比，TB 与更高的一致性率相关，包括在 PS 匹配前后（优势比[OR]：1.13；P=0.04）和 1:3 PS 匹配后（OR：1.15；P=0.03）。在 TB 患者中，年龄（OR：0.98；P=0.04）、最大癌核累及（MCCI；OR：1.02；P=0.02）和最大癌核长度（MCCL；OR：1.01；P=0.07）与 ISUP GG 一致性相关。此外，PSA-D 较高时，一致性率有降低的趋势（OR：0.77；P=0.1）。最后，mpMRI 中中间病变位置与最低的一致性率相关（44%）。

结论

在初次活检的接受 RP 治疗的患者中，与 SB 相比，TB 实现了更高的 ISUP GG 一致性率，但同样存在 csPCa 漏诊的情况。此外，只有 ISUP GG≥2 的患者，而不是 ISUP GG1 的患者，表现出更高的一致性率。最后，年龄、MCCI、MCCL、PSA-D 和病变位置与 TB 和 RP 之间的一致性相关。