Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom.
Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
J Urol. 2021 Apr;205(4):1075-1081. doi: 10.1097/JU.0000000000001476. Epub 2020 Nov 18.
We compared clinically significant prostate cancer detection by visual estimation and image fusion targeted transperineal prostate biopsy.
This multicenter study included patients with multiparametric magnetic resonance imaging lesions undergoing visual estimation or image fusion targeted transperineal biopsy (April 2017-March 2020). Propensity score matching was performed using demographics (age and ethnicity), clinical features (prostate specific antigen, prostate volume, prostate specific antigen density and digital rectal examination), multiparametric magnetic resonance imaging variables (number of lesions, PI-RADS® score, index lesion diameter, whether the lesion was diffuse and radiological T stage) and biopsy factors (number of cores, operator experience and anesthetic type). Matched groups were compared overall and by operator grade, PI-RADS score, lesion multiplicity, prostate volume and anesthetic type using targeted-only and targeted plus systematic histology. Multiple clinically significant prostate cancer thresholds were evaluated (primary: Gleason ≥3+4).
A total of 1,071 patients with a median age of 67.3 years (IQR 61.3-72.4), median prostate specific antigen of 7.5 ng/ml (IQR 5.3-11.2) and 1,430 total lesions underwent targeted-only biopsies (visual estimation: 372 patients, 494 lesions; image fusion: 699 patients, 936 lesions). A total of 770 patients with a median age of 67.4 years (IQR 61-72.1), median prostate specific antigen of 7.1 ng/ml (IQR 5.2-10.6) and 919 total lesions underwent targeted plus systematic biopsies (visual estimation: 271 patients, 322 lesions; image fusion: 499 patients, 597 lesions). Matched comparisons demonstrated no overall difference in clinically significant prostate cancer detection between visual estimation and image fusion (primary: targeted-only 54% vs 57.4%, p=0.302; targeted plus systematic 51.2% vs 58.2%, p=0.123). Senior urologists had significantly higher detection rates using image fusion (primary: targeted-only 45.4% vs 63.7%, p=0.001; targeted plus systematic 39.4% vs 64.5%, p <0.001).
We found no overall difference in clinically significant prostate cancer detection, although image fusion may be superior in experienced hands.
我们比较了经会阴前列腺靶向活检中通过目测估计和图像融合来检测临床显著前列腺癌的效果。
这项多中心研究纳入了 2017 年 4 月至 2020 年 3 月期间接受多参数磁共振成像病变经会阴前列腺靶向活检的患者。使用人口统计学（年龄和种族）、临床特征（前列腺特异性抗原、前列腺体积、前列腺特异性抗原密度和直肠指检）、多参数磁共振成像变量（病变数量、PI-RADS 评分、病灶直径、病变是否弥漫以及影像学 T 分期）和活检因素（活检针数、操作者经验和麻醉类型）进行倾向评分匹配。通过仅靶向活检和靶向加系统活检，对总体和按操作者级别、PI-RADS 评分、病变多发性、前列腺体积和麻醉类型进行匹配组比较。评估了多个临床显著前列腺癌阈值（原发性：Gleason 评分≥3+4）。
共 1071 名中位年龄为 67.3 岁（IQR 61.3-72.4）、中位前列腺特异性抗原为 7.5ng/ml（IQR 5.3-11.2）和 1430 个总病变的患者接受了仅靶向活检（目测估计：372 名患者，494 个病变；图像融合：699 名患者，936 个病变）。共 770 名中位年龄为 67.4 岁（IQR 61-72.1）、中位前列腺特异性抗原为 7.1ng/ml（IQR 5.2-10.6）和 919 个总病变的患者接受了靶向加系统活检（目测估计：271 名患者，322 个病变；图像融合：499 名患者，597 个病变）。匹配比较表明，目测估计和图像融合在检测临床显著前列腺癌方面总体上没有差异（原发性：仅靶向 54%比 57.4%，p=0.302；靶向加系统 51.2%比 58.2%，p=0.123）。资深泌尿科医生使用图像融合的检测率显著更高（原发性：仅靶向 45.4%比 63.7%，p=0.001；靶向加系统 39.4%比 64.5%，p<0.001）。
我们没有发现检测临床显著前列腺癌方面的总体差异，尽管图像融合在经验丰富的医生手中可能更有优势。
