Sugano Dordaneh, Kaneko Masatomo, Yip Wesley, Lebastchi Amir H, Cacciamani Giovanni E, Abreu Andre Luis
USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Center for Image-Guided and Focal Therapy for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA.
Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Cancers (Basel). 2021 Mar 22;13(6):1449. doi: 10.3390/cancers13061449.
In this review, we evaluated literature regarding different modalities for multiparametric magnetic resonance imaging (mpMRI) and mpMRI-targeted biopsy (TB) for the detection of prostate cancer (PCa). We identified studies evaluating systematic biopsy (SB) and TB in the same patient, thereby allowing each patient to serve as their own control. Although the evidence supports the accuracy of TB, there is still a proportion of clinically significant PCa (csPCa) that is detected only in SB, indicating the importance of maintaining SB in the diagnostic pathway, albeit with additional cost and morbidity. There is a growing subset of data which supports the role of TB alone, which may allow for increased efficiency and decreased complications. We also compared the literature on transrectal (TR) vs. transperineal (TP) TB. Although further high-level evidence is necessary, current evidence supports similar csPCa detection rate for both approaches. We also evaluated various TB techniques such as cognitive fusion biopsy (COG-TB) and in-bore biopsy (IB-TB). COG-TB has comparable detection rates to software fusion, but is operator-dependent and may have reduced accuracy for smaller lesions. IB-TB may allow for greater precision as lesions are directly targeted; however, this is costly and time-consuming, and does not account for MRI-invisible lesions.
在本综述中，我们评估了有关多参数磁共振成像（mpMRI）及mpMRI靶向活检（TB）用于检测前列腺癌（PCa）的不同方式的文献。我们纳入了评估同一患者系统活检（SB）和TB的研究，从而使每位患者都能作为自身对照。尽管有证据支持TB的准确性，但仍有一部分临床显著前列腺癌（csPCa）仅在SB中被检测到，这表明在诊断流程中保留SB很重要，尽管其会增加成本和发病率。越来越多的数据子集支持单独使用TB的作用，这可能会提高效率并减少并发症。我们还比较了经直肠（TR）与经会阴（TP）TB的相关文献。尽管还需要进一步的高级别证据，但目前的证据支持两种方法的csPCa检测率相似。我们还评估了各种TB技术，如认知融合活检（COG-TB）和腔内活检（IB-TB）。COG-TB与软件融合的检测率相当，但依赖操作者，对较小病变的准确性可能会降低。IB-TB可能会因直接针对病变而具有更高的精准度；然而，这成本高且耗时，并且无法检测出MRI不可见的病变。
