磁共振成像/超声融合引导前列腺活检在主动监测中的应用：我们的经验。

MRI/US fusion prostate biopsy in men on active surveillance: Our experience.

机构信息

Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro.

Università Politecnica delle Marche-Azienda Ospedaliera Ospedali Riuniti Torrette di Ancona.

出版信息

Arch Ital Urol Androl. 2021 Mar 22;93(1):88-91. doi: 10.4081/aiua.2021.1.88.

DOI:10.4081/aiua.2021.1.88

PMID:33754618

Abstract

AIM

The upgrading or staging in men with prostate cancer (PCA) undergoing active surveillance (AS), defined as Gleason score (GS) ≥ 3+4 or more than 2 area with cancer, was investigated in our experience using the software-based fusion biopsy (FB).

METHODS

We selected from our database, composed of 620 biopsies, only men on AS according to criteria of John Hopkins Protocol (T1c, < 3 positive cores, GS = 3+3 = 6). Monitoring consisted of PSA measurement every 3 months, a clinical examination every 6 months, confirmatory FB within 6 months and then annual FB in all men. The suspicious MRI lesions were scored according to the Prostate Imaging Reporting and Data System (PI-RADS) classification version 2. FB were performed with a transrectal elastic free-hand fusion platform. The overall and clinically significant cancer detection rate was reported. Secondary, the diagnostic role of systematic biopsies was evaluated.

RESULTS

We selected 56 patients on AS with mean age 67.4 years, mean PSA 6.7 ng/ml and at least one follow-up MRI-US fusion biopsy (10 had 2 or 3 follow-up biopsies). Lesions detected by MRI were: PIRADS-2 in 5, PIRADS-3 in 28, PIRADS-4 in 18 pts and PIRADS-5 in 5 patients. In each MRI lesion, FB with 2.1 ± 1.1 cores were taken with a mean total cores of 13 ± 2.4 including the systematic cores. The overall cancer detection rate was 71% (40/56): 62% (25/40) in target core and 28% (15/40) in systematic core. The overall significant cancer detection rate was 46% (26/56): 69% (18/26) in target vs 31% (8/26) in random cores.

CONCLUSIONS

The incidence of clinical significant cancer was 46% in men starting active surveillance, but it was more than doubled using MRI/US Target Biopsy 69% (18/26) rather than random cores (31%, 8/26). However, 1/3 of disease upgrades would have been missed if only the targeted biopsies were performed. Based on our experience, MRI/US fusion target biopsy must be associated to systematic biopsies to improve detection of significant cancer, reducing the risks of misclassification.

摘要

目的

本研究旨在探讨在接受主动监测（AS）的前列腺癌（PCA）男性中，基于软件的融合活检（FB）在升级或分期中的作用，定义为 Gleason 评分（GS）≥3+4 或有 2 个以上区域有癌症。

方法

我们从我们的数据库中选择了仅符合约翰霍普金斯方案（T1c，<3 个阳性核心，GS=3+3=6）标准的 AS 男性。监测包括每 3 个月测量 PSA，每 6 个月进行一次临床检查，在 6 个月内进行确认性 FB，然后所有男性每年进行 FB。可疑 MRI 病变根据前列腺成像报告和数据系统（PI-RADS）分类版本 2 进行评分。FB 使用经直肠弹性徒手融合平台进行。报告了总体和临床显著癌症检出率。其次，评估了系统活检的诊断作用。

结果

我们选择了 56 名接受 AS 治疗的男性，平均年龄 67.4 岁，平均 PSA 6.7ng/ml，至少进行了一次 MRI-US 融合活检（10 名男性进行了 2 次或 3 次随访活检）。MRI 检测到的病变为：PIRADS-2 级 5 例，PIRADS-3 级 28 例，PIRADS-4 级 18 例，PIRADS-5 级 5 例。在每个 MRI 病变中，使用 2.1±1.1 个核心进行 FB，平均总核心数为 13±2.4 个，包括系统核心。总体癌症检出率为 71%（40/56）：靶核心 62%（25/40），系统核心 28%（15/40）。总体显著癌症检出率为 46%（26/56）：靶核心 69%（18/26），随机核心 31%（8/26）。

结论

开始接受主动监测的男性中临床显著癌症的发生率为 46%，但使用 MRI/US 靶活检时，发生率增加到 69%（18/26），而随机活检的发生率为 31%（8/26）。然而，如果仅进行靶向活检，将会错过 1/3 的疾病升级。基于我们的经验，MRI/US 融合靶活检必须与系统活检相结合，以提高显著癌症的检出率，降低误诊风险。