Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Abdom Radiol (NY). 2020 Dec;45(12):4166-4177. doi: 10.1007/s00261-020-02667-4. Epub 2020 Jul 31.
To investigate whether the detection of clinically significant prostate cancer (csPCa) and the added value of focal saturation biopsy and systematic biopsy (SBx) differ according to index lesion size, and to compare the current guidelines for csPCa detection.
This retrospective study included consecutive men who underwent MRI and subsequent SBx and MRI-targeted biopsy (TBx) for a suspicious lesion between April 2019 and February 2020. Lesion visibility on transrectal ultrasound (US) and added value of focal saturation biopsy and SBx were compared according to index lesion size using chi-square and McNemar tests. csPCa detection rates and the proportion of biopsy-indicated men were compared among four biopsy strategies based on current guidelines.
Of 313 men evaluated (median age, 65; interquartile range 60‒71), csPCa was detected in 110 (35%). In lesions < 10 mm, greater US invisibility (42.7% of lesions < 10 mm versus 20.0% of lesions ≥ 10 mm; p < 0.001) and higher added value of focal saturation biopsy and SBx (11.1% and 17.1% in lesions < 10 mm versus 4.2% and 6.3% in lesions ≥ 10 mm) were observed, compared with lesions ≥ 10 mm. Consideration of prostate-specific antigen (PSA) density > 0.15 ng/mL/mL as a cutoff in unsuspicious MRI led to a 14% reduction (44/313) in men who needed biopsy.
Determination of the biopsy strategy in terms of the need for focal saturation biopsy or SBx should be made considering lesion size. The use of PSA density in non-suspicious MRI can lead to a reduction in biopsy-indicated men.
探讨可疑前列腺癌（csPCa）的检测是否与病灶大小有关，以及局灶性饱和活检和系统活检（SBx）的附加价值是否不同，并比较当前 csPCa 检测指南。
本回顾性研究纳入了 2019 年 4 月至 2020 年 2 月期间因可疑病灶接受 MRI 检查和随后 SBx 及 MRI 靶向活检（TBx）的连续男性患者。使用卡方检验和 McNemar 检验比较经直肠超声（TRUS）上病灶的可视性以及局灶性饱和活检和 SBx 的附加价值与病灶大小的关系。根据当前指南，比较了 4 种活检策略下 csPCa 的检出率和需要活检的患者比例。
在 313 例接受评估的男性患者中（中位年龄 65 岁，四分位间距 60-71 岁），110 例（35%）患者检出 csPCa。在病灶<10mm 时，TRUS 上的病灶可视性更低（42.7%的病灶<10mm 与 20.0%的病灶≥10mm相比；p<0.001），局灶性饱和活检和 SBx 的附加价值更高（病灶<10mm 时分别为 11.1%和 17.1%，病灶≥10mm 时分别为 4.2%和 6.3%）。考虑将前列腺特异性抗原（PSA）密度>0.15ng/mL/ml 作为可疑 MRI 中的截断值，可使需要活检的男性患者减少 14%（44/313）。
根据需要进行局灶性饱和活检或 SBx 的策略，应考虑病灶大小。在非可疑 MRI 中使用 PSA 密度可以减少需要活检的患者数量。
