Department of Diagnostic Radiology, Oregon Health and Science University, Mail Code L340, 3181 SW Sam Jackson Park Rd, Portland, OR 97239.
Biostatistics Shared Resources, Oregon Health and Science University, Portland, OR.
AJR Am J Roentgenol. 2021 Nov;217(5):1123-1130. doi: 10.2214/AJR.20.25207. Epub 2021 Mar 21.
Few published studies have compared in-bore and fusion MRI-targeted prostate biopsy, and the available studies have had conflicting results. The purpose of this study was to compare the target-specific cancer detection rate of in-bore prostate biopsy with that of fusion MRI-targeted biopsy. The records of men who underwent in-bore or fusion MRI-targeted biopsy of PI-RADS category 4 or 5 lesions between August 2013 and September 2019 were retrospectively identified. PI-RADS version 2.1 assessment category, size, and location of each target were established by retrospective review by a single experienced radiologist. Patient history and target biopsy results were obtained by electronic medical record review. Only the first MRI-targeted biopsy of the dominant lesion was included for patients with repeated biopsies or multiple targets. In-bore and fusion biopsy were compared by propensity score weights and multivariable regression to adjust for imbalances in patient and target characteristics between biopsy techniques. The primary endpoint was target-specific prostate cancer detection rate. Secondary endpoints were detection rate after application of propensity score weighting for cancers in International Society of Urological Pathology (ISUP) grade group 2 (GG2) or higher and detection rate with the use of off-target systematic sampling results. The study sample included 286 men (in-bore biopsy, 191; fusion biopsy, 95). Compared with fusion biopsy, in-bore biopsy was associated with significantly greater likelihood of detection of any cancer (odds ratio, 2.28 [95% CI, 1.04-4.98]; = .04) and nonsignificantly greater likelihood of detection of ISUP GG2 or higher cancer (odds ratio, 1.57 [95% CI, 0.88-2.79]; = .12) in a target. When off-target sampling was included, in-bore biopsy and combined fusion and systematic biopsy were not different for detection of any cancer (odds ratio, 1.16 [95% CI, 0.54-2.45]; = .71) or ISUP GG2 and higher cancer (odds ratio, 1.15 [95% CI, 0.66-2.01]; = .62). In this retrospective study in which propensity score weighting was used, in-bore MRI-targeted prostate biopsy had a higher target-specific cancer detection rate than did fusion biopsy. Pending a larger prospective randomized multicenter comparison between in-bore and fusion biopsy, in-bore may be the preferred approach should performing only biopsy of a suspicious target, without concurrent systematic biopsy, be considered clinically appropriate.
很少有发表的研究比较过腔内和融合 MRI 靶向前列腺活检，并且现有研究的结果存在冲突。本研究旨在比较腔内前列腺活检与融合 MRI 靶向活检的靶向特异性癌症检出率。回顾性地确定了 2013 年 8 月至 2019 年 9 月期间接受 PI-RADS 类别 4 或 5 病变的腔内或融合 MRI 靶向活检的男性患者的记录。通过单一经验丰富的放射科医生的回顾性评估，建立了 PI-RADS 版本 2.1 评估类别、大小和每个目标的位置。通过电子病历回顾获得患者病史和目标活检结果。对于接受重复活检或多个目标的患者，仅纳入首次 MRI 靶向主导病变活检。通过倾向评分权重和多变量回归比较腔内和融合活检，以调整两种活检技术之间患者和目标特征的不平衡。主要终点是靶向特异性前列腺癌检出率。次要终点是在应用国际泌尿病理学会 (ISUP) 分级组 2 (GG2) 或更高的癌症的倾向评分加权和应用非靶向系统采样结果后的检出率。该研究样本包括 286 名男性（腔内活检 191 例，融合活检 95 例）。与融合活检相比，腔内活检与任何癌症的检测可能性显著增加（优势比，2.28 [95%CI，1.04-4.98]； =.04），并且与 ISUP GG2 或更高癌症的检测可能性显著增加（优势比，1.57 [95%CI，0.88-2.79]； =.12）在一个目标中。当纳入非靶向采样时，腔内活检和融合及系统联合活检在检测任何癌症（优势比，1.16 [95%CI，0.54-2.45]； =.71）或 ISUP GG2 和更高癌症（优势比，1.15 [95%CI，0.66-2.01]； =.62）方面没有差异。在这项使用倾向评分加权的回顾性研究中，腔内 MRI 靶向前列腺活检的靶向特异性癌症检出率高于融合活检。在腔内和融合活检之间进行更大的前瞻性随机多中心比较之前，如果临床上认为只对可疑目标进行活检，而不进行同时的系统活检是合适的，那么腔内可能是首选方法。
