Department of Urology, Peking University First Hospital, Beijing, China.
Institute of Urology, Peking University, Beijing, China.
J Urol. 2020 Dec;204(6):1202-1208. doi: 10.1097/JU.0000000000001302. Epub 2020 Jul 27.
In this study we determined the optimal number of transperineal magnetic resonance imaging ultrasound fusion targeted biopsy cores per lesion needed for the detection of clinically significant prostate cancer.
A total of 101 patients with at least 1 lesion with a PI-RADS® (Prostate Imaging Reporting and Data System) score of 3 or greater were recruited prospectively. At least 4 transperineal magnetic resonance imaging ultrasound fusion targeted biopsy cores per lesion were performed, followed by systematic biopsy. The Kappa test was used to evaluate the consistency of the clinically significant prostate cancer detection rate between different targeted biopsy cores and 4 or more cores, which was regarded as reference standard.
In the total cohort of 101 patients 49 (48.5%), 55 (54.5%) and 57 (56.4%) were diagnosed with clinically significant prostate cancer by systematic biopsy, targeted biopsy or targeted biopsy plus systematic biopsy, respectively. As for the total of 161 lesions, the clinically significant prostate cancer detection rate based on 1, 2, 3, or 4 or more targeted biopsy cores was made in 27.3%, 32.9%, 37.3% and 39.1%, respectively. Three cores showed great consistency with 4 or more cores in clinically significant prostate cancer detection rate (Kappa coefficient of 0.961, p <0.001) with a sensitivity of 95.2% (95% CI 85.8-98.8), and only missed 3 lesions harboring clinically significant prostate cancer. Similar results were obtained in cases with PI-RADS 3 or 4 or maximal diameter of less than 1.5 cm.
Three targeted biopsies per lesion were suitable during transperineal magnetic resonance imaging ultrasound fusion biopsy, especially for lesions of PI-RADS 3 or 4, or small lesions (maximal diameter less than 1.5 cm), which may help to tailor targeted prostate biopsy procedures.
本研究旨在确定经会阴磁共振成像超声融合靶向活检每例病变所需的最佳活检核心数量，以检测临床显著前列腺癌。
前瞻性招募了至少 1 个 PI-RADS（前列腺成像报告和数据系统）评分≥3 的病变患者 101 例。对每个病变至少进行 4 次经会阴磁共振成像超声融合靶向活检，然后进行系统活检。采用 Kappa 检验评估不同靶向活检核心数与 4 个或更多核心数之间临床显著前列腺癌检出率的一致性，后者被视为参考标准。
在 101 例患者的总队列中，系统活检、靶向活检和靶向活检加系统活检分别诊断出 49（48.5%）、55（54.5%）和 57（56.4%）例临床显著前列腺癌。对于 161 个病变，基于 1、2、3 或 4 个或更多靶向活检核心的临床显著前列腺癌检出率分别为 27.3%、32.9%、37.3%和 39.1%。在临床显著前列腺癌检出率方面，3 个核心与 4 个或更多核心具有很好的一致性（Kappa 系数为 0.961，p<0.001），敏感性为 95.2%（95%CI 85.8-98.8%），仅漏诊 3 例临床显著前列腺癌病变。在 PI-RADS 3 或 4 或最大直径小于 1.5cm 的病例中也得到了类似的结果。
经会阴磁共振成像超声融合靶向活检时，每个病变进行 3 次靶向活检较为合适，尤其是针对 PI-RADS 3 或 4 或较小病变（最大直径小于 1.5cm），这有助于定制靶向前列腺活检方案。
