Cata Emanuel, Andras Iulia, Ferro Matteo, Kadula Pierre, Leucuta Daniel, Musi Gennaro, Matei Deliu-Victor, De Cobelli Ottavio, Tamas-Szora Attila, Caraiani Cosmin, Lebovici Andrei, Epure Flavia, Bungardean Maria, Coman Radu-Tudor, Crisan Nicolae
Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
Urology Department, Municipal Hospital, Cluj Napoca, Romania.
Transl Androl Urol. 2020 Dec;9(6):2510-2518. doi: 10.21037/tau-20-1001.
Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy have become an integral part of the diagnosis of prostate cancer (PCa), as recommended by the European Association of Urology Guidelines. The aim of the current study was to evaluate the performance of MRI and MRI-transrectal ultrasound (TRUS) fusion prostate biopsy as first biopsy setting in a tertiary center.
A cohort of 300 patients was included in the current analysis. All patients presented with clinical or biochemical suspicion of PCa and harbored at least one suspect lesion on mpMRI. MRI-TRUS fusion prostate biopsy, followed by 12 core systematic prostate biopsy were performed by the same operator using a rigid registration system.
The mean age of the patients was 64 years (IQR: 58-68.5 years) and the mean PSA was 6.35 ng/mL (IQR: 4.84-9.46 ng/mL). Overall cancer and csPCa diagnosis rates were 47% and 40.66%. Overall PCa/csPCa detection rates were 20.4%/11.1%, 52%/45% and 68.5%/66.7% for PI-RADS lesions 3, 4 and 5 (P<0.001/P<0.0001). Larger lesion diameter and lesion volume were associated with PCa diagnosis (P=0.006 and P=0.001, respectively). MRI-TRUS fusion biopsy missed PCa diagnosis in 37 cases (of whom 48.6% ISUP 1) in comparison with 9 patients missed by systematic biopsy (of whom 11.1% ISUP 1). In terms of csPCa, systematic biopsy missed 77.7% of the tumors located in the anterior and transitional areas. The rate of csPCa was highest when targeted biopsy was associated with systematic biopsy: 86.52% 68.79% for targeted biopsy 80.14% for systematic biopsy, P=0.0004. In 60.6% of cases, systematic biopsy was positive for PCa at the same site as the targeted lesion. Of these patients, eight harbored csPCa and were diagnosed exclusively on systematic biopsy.
MRI-TRUS fusion prostate biopsy improves the diagnosis of csPCa. The main advantage of an MRI-guided approach is the diagnosis of anterior and transitional area tumors. The best results in terms of csPCa diagnosis are obtained by the combination of MRI-TRUS fusion with systematic biopsy. The systematic biopsy performed during MRI-targeted biopsy could have an important role in overcoming errors of MRI-TRUS fusion systems.
多参数磁共振成像（mpMRI）和靶向活检已成为前列腺癌（PCa）诊断的重要组成部分，这是欧洲泌尿外科学会指南所推荐的。本研究的目的是评估在三级中心将MRI和MRI-经直肠超声（TRUS）融合前列腺活检作为首次活检方法的性能。
本分析纳入了300例患者。所有患者均有临床或生化方面对PCa的怀疑，且在mpMRI上至少有一个可疑病变。由同一名操作者使用刚性配准系统进行MRI-TRUS融合前列腺活检，随后进行12针系统前列腺活检。
患者的平均年龄为64岁（四分位间距：58 - 68.5岁），平均前列腺特异性抗原（PSA）为6.35 ng/mL（四分位间距：4.84 - 9.46 ng/mL）。总体癌症和临床显著前列腺癌（csPCa）诊断率分别为47%和40.66%。对于前列腺影像报告和数据系统（PI-RADS）3、4和5类病变，总体PCa/csPCa检出率分别为20.4%/11.1%、52%/45%和68.5%/66.7%（P<0.001/P<0.0001）。更大的病变直径和病变体积与PCa诊断相关（分别为P = 0.006和P = 0.001）。与系统活检漏诊的9例患者（其中11.1%为国际泌尿病理学会（ISUP）1级）相比，MRI-TRUS融合活检漏诊了37例PCa患者（其中48.6%为ISUP 1级）。就csPCa而言，系统活检漏诊了位于前部和移行区的77.7%的肿瘤。当靶向活检与系统活检联合时，csPCa的检出率最高：靶向活检为86.52%，系统活检为68.79%，联合活检为80.14%，P = 0.0004。在60.6%的病例中，系统活检在与靶向病变相同的部位对PCa呈阳性。在这些患者中，有8例患有csPCa，且仅通过系统活检被诊断出来。
MRI-TRUS融合前列腺活检可改善csPCa的诊断。MRI引导方法的主要优势在于诊断前部和移行区肿瘤。在csPCa诊断方面，通过将MRI-TRUS融合与系统活检相结合可获得最佳结果。在MRI靶向活检期间进行的系统活检在克服MRI-TRUS融合系统的误差方面可能具有重要作用。
