Thomson Alice, Li Mo, Grummet Jeremy, Sengupta Shomik
Urology Department, Eastern Health, Box Hill, Victoria, Australia.
Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.
Transl Androl Urol. 2020 Dec;9(6):3009-3017. doi: 10.21037/tau.2019.12.40.
As the second most diagnosed cancer worldwide, prostate cancer is confirmed via tissue biopsy. Given the large number of prostate biopsies performed each year, the technique should be as accurate and safe as possible for the patient's well-being. Transrectal ultrasound guided prostate biopsy (TRUS-biopsy) is most offered worldwide. Transperineal biopsy (TPP-biopsy), on the other hand, has been gaining popularity due to its superior sensitivity and lower rate of sepsis. This article offers a review of the brachytherapy grid technique used to perform a TPP-biopsy, as well as a discussion of possible variations in the procedure. TPP-biopsy is typically performed under general anaesthesia with patient in lithotomy. Through the perineum, cores of tissue are taken systematically, with or without targeting, under US guidance. Different fusion techniques (cognition, MRI-US fusion software, MRI in-bore) can be used to target pre-identified lesions on MRI. The sampling can be done either by free hand or using a brachytherapy grid. Robotic assisted prostate biopsy is also available on the market as an alternative. In recent years, there has been accumulating evidence showing that it is safe and feasible to perform TPPB under local anaesthesia. This may improve the uptake of TPPB as the preferred biopsy technique for prostate cancer.
作为全球第二大最常被诊断出的癌症，前列腺癌通过组织活检来确诊。鉴于每年进行大量的前列腺活检，就患者的健康而言，该技术应尽可能准确和安全。经直肠超声引导下的前列腺活检（TRUS活检）在全球范围内应用最为广泛。另一方面，经会阴活检（TPP活检）因其更高的敏感性和更低的败血症发生率而越来越受到欢迎。本文对用于进行TPP活检的近距离放疗网格技术进行了综述，并讨论了该手术可能的变体。TPP活检通常在全身麻醉下、患者取截石位时进行。在超声引导下，通过会阴有系统地获取组织芯，无论是否进行靶向操作。可使用不同的融合技术（认知、MRI-US融合软件、孔内MRI）来靶向MRI上预先确定的病变。采样可以徒手进行，也可以使用近距离放疗网格。市场上也有机器人辅助前列腺活检作为替代方案。近年来，越来越多的证据表明在局部麻醉下进行TPPB是安全可行的。这可能会提高TPPB作为前列腺癌首选活检技术的接受度。
