Case Western Reserve University School of Medicine, Health Education Campus, Cleveland, OH.
Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
AJR Am J Roentgenol. 2021 Oct;217(4):908-918. doi: 10.2214/AJR.20.24918. Epub 2020 Dec 18.
In-gantry MRI-guided biopsy (MRGB) of the prostate has been shown to be more accurate than other targeted prostate biopsy methods. However, the optimal number of cores to obtain during in-gantry MRGB remains undetermined. The purpose of this study was to assess the diagnostic yield of obtaining an incremental number of cores from the primary lesion and of second lesion sampling during in-gantry MRGB of the prostate. This retrospective study included 128 men with 163 prostate lesions who underwent in-gantry MRGB between 2016 and 2019. The men had a total of 163 lesions sampled with two or more cores, 121 lesions sampled with three or more cores, and 52 lesions sampled with four or more cores. A total of 40 men underwent sampling of a second lesion. Upgrade on a given core was defined as a greater International Society of Urological Pathology (ISUP) grade group (GG) relative to the previously obtained cores. Clinically significant prostate cancer (csPCa) was defined as ISUP GG 2 or greater. The frequency of any upgrade was 12.9% (21/163) on core 2 versus 10.7% (13/121) on core 3 ( = .29 relative to core 2) and 1.9% (1/52) on core 4 ( = .03 relative to core 3). The frequency of upgrade to csPCa was 7.4% (12/163) on core 2 versus 4.1% (5/121) on core 3 ( = .13 relative to core 2) and 0% (0/52) on core 4 ( = .07 relative to core 3). The frequency of upgrade on core 2 was higher for anterior lesions ( < .001) and lesions with a higher PI-RADS score ( = .007); the frequency of upgrade on core 3 was higher for apical lesions ( = .01) and lesions with a higher PI-RADS score ( = .01). Sampling of a second lesion resulted in an upgrade in a single patient (2.5%; 1/40); both lesions were PI-RADS category 4 and showed csPCa. When performing in-gantry MRGB of the prostate, obtaining three cores from the primary lesion is warranted to optimize csPCa diagnosis. Obtaining a fourth core from the primary lesion or sampling a second lesion has very low yield in upgrading cancer diagnoses. To reduce patient discomfort and procedure times, operators may refrain from obtaining more than three cores or second lesion sampling.
在龙门架 MRI 引导下对前列腺进行活检（MRGB）已被证明比其他靶向前列腺活检方法更准确。然而，在龙门架 MRI 引导下前列腺活检中获得的最佳核心数量仍未确定。本研究的目的是评估在龙门架 MRI 引导下对前列腺的主要病变和第二病变进行增量核心取样的诊断效果。本回顾性研究纳入了 128 名男性，共 163 个前列腺病变，他们在 2016 年至 2019 年间接受了龙门架 MRI 引导下的活检。这些男性的总共有 163 个病变采用了 2 个或更多核心进行取样，121 个病变采用了 3 个或更多核心进行取样，52 个病变采用了 4 个或更多核心进行取样。共有 40 名男性接受了第二病变的取样。给定核心的升级定义为相对于之前获得的核心，国际泌尿病理学会（ISUP）分级组（GG）更高。临床显著前列腺癌（csPCa）定义为 ISUP GG 2 或更高。在第 2 个核心上的任何升级频率为 12.9%（21/163），而在第 3 个核心上为 10.7%（13/121）（与第 2 个核心相比为.29），在第 4 个核心上为 1.9%（1/52）（与第 3 个核心相比为.03）。在第 2 个核心上升级为 csPCa 的频率为 7.4%（12/163），而在第 3 个核心上为 4.1%（5/121）（与第 2 个核心相比为.13），在第 4 个核心上为 0%（0/52）（与第 3 个核心相比为.07）。第 2 个核心的升级频率在前侧病变中更高（<.001），在 PI-RADS 评分较高的病变中更高（<.007）；第 3 个核心的升级频率在顶部病变中更高（<.01），在 PI-RADS 评分较高的病变中更高（<.01）。对第二个病变进行取样导致单个患者升级（2.5%；1/40）；两个病变均为 PI-RADS 类别 4，显示 csPCa。在对前列腺进行龙门架 MRI 引导下活检时，从主要病变中获得 3 个核心是有必要的，以优化 csPCa 诊断。从主要病变中获得第 4 个核心或对第二个病变进行取样在提高癌症诊断方面的效果非常低。为了减少患者不适和手术时间，操作人员可能会避免获得超过 3 个核心或第二个病变取样。
