术前靶向活检与根治性前列腺切除术组织病理分析的 Gleason 分级组一致性：在孔内 MRI 引导与 MRI-经直肠超声融合前列腺活检之间的比较。
Gleason Grade Group Concordance between Preoperative Targeted Biopsy and Radical Prostatectomy Histopathologic Analysis: A Comparison Between In-Bore MRI-guided and MRI-Transrectal US Fusion Prostate Biopsies.
机构信息
Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390.
出版信息
Radiol Imaging Cancer. 2021 Mar 5;3(2):e200123. doi: 10.1148/rycan.2021200123. eCollection 2021 Mar.
PURPOSE
To determine and compare rates of grade group (GG) discrepancies between different targeted biopsy techniques (in-bore vs fusion) after propensity score weighting using whole-mount radical prostatectomy (RP) histopathologic analysis as the reference standard.
MATERIALS AND METHODS
This retrospective study evaluated men who underwent targeted (fusion or in-bore) biopsy between April 2017 and January 2019 followed by prostatectomy. The primary endpoint of the study was a change in GG from biopsy to RP at a patient level. For downgrade and upgrade analysis, men with biopsy GG1 (downgrade not possible) and GG5 (upgrade not possible) were excluded, respectively. GG upgrade, downgrade, and concordance rates of each targeting approach were compared using propensity score weighting and logistic regression with inverse probability of treatment weighting. Significance level was set at .05. Index lesion GG on RP specimen served as the reference standard.
RESULTS
A total of 191 men (90 in the in-bore [mean age, 63 years ± 7 (standard deviation)] and 101 in the fusion biopsy group [mean age, 65 years ± 7]) were eligible and included. Fewer GG upgrades were noted in the in-bore biopsy group (14%; 12 of 85) compared with the fusion plus systematic biopsy group (30%; 28 of 93) ( = .012). The incidence of GG downgrade in the in-bore group (25%; 21 of 84) was higher than in the fusion group (17%; 16 of 93); however, the difference was not statistically significant ( = .2). Of the 77 men misclassified by both biopsy techniques, the majority (56%, = 43) had a change in GG of 2 to 3 or 3 to 2.
CONCLUSION
Superior sampling accuracy with MRI-guided in-bore biopsies offers a lower incidence of GG upgrades compared with MRI-transrectal US fusion biopsies upon RP. Biopsy/Needle Aspiration, MR-Imaging, Oncology, Pathology, Prostate © RSNA, 2021.
目的
使用全器官前列腺根治切除术（RP）组织病理学分析作为参考标准，通过倾向评分加权，确定并比较不同靶向活检技术（腔内与融合）后的分级组（GG）差异率。
材料与方法
本回顾性研究评估了 2017 年 4 月至 2019 年 1 月期间接受靶向（融合或腔内）活检并随后接受前列腺切除术的男性患者。研究的主要终点是患者水平活检至 RP 时 GG 的变化。对于降级和升级分析，分别排除活检 GG1（不可能降级）和 GG5（不可能升级）的男性。使用倾向评分加权和逆概率治疗加权的逻辑回归比较每种靶向方法的 GG 升级、降级和一致性率。显著性水平设置为.05。RP 标本上的索引病变 GG 作为参考标准。
结果
共纳入 191 名男性患者（腔内 90 例[平均年龄，63 岁±7（标准差）]，融合活检组 101 例[平均年龄，65 岁±7]）。腔内活检组 GG 升级较少（14%，85 例中有 12 例），而融合加系统活检组 GG 升级较多（30%，93 例中有 28 例）（ =.012）。腔内组 GG 降级发生率（25%，84 例中有 21 例）高于融合组（17%，93 例中有 16 例）；然而，差异无统计学意义（ =.2）。在两种活检技术均误诊的 77 名男性中，大多数（56%，=43）GG 变化为 2 级到 3 级或 3 级到 2 级。
结论
与 MRI-经直肠超声融合活检相比，MRI 引导的腔内活检具有更高的采样准确性，可降低 RP 时 GG 升级的发生率。活检/针吸术、磁共振成像、肿瘤学、病理学、前列腺 © RSNA，2021。
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