Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Abdom Radiol (NY). 2021 Oct;46(10):4974-4983. doi: 10.1007/s00261-021-03179-5. Epub 2021 Jun 28.
This study aimed to analyze the diagnostic yield of modified transrectal ultrasound (TRUS)-guided 12-core combined biopsy (CB) using prebiopsy magnetic resonance imaging (MRI) for detecting clinically significant prostate cancer (csPCa).
This retrospective study included 130 consecutive patients who underwent modified TRUS-guided 12-core CB using cognitive fusion for lesions of Prostate Imaging-Reporting and Data System (PI-RADS) category ≥ 3. The 12-core CB comprised 3-6-core targeted biopsy (TB) and systematic biopsy (SB). For SB, tissue sampling in TB regions was omitted, and 3-core sampling (i.e., apex, mid, and base) in the contralateral peripheral zone of TB was mandatory. csPCa was defined as International Society of Urological Pathology (ISUP) grade ≥ 2 cancer. The per-patient cancer detection rates (CDRs) according to biopsy type or PI-RADS category were investigated.
The CDRs of TB, SB, and CB for csPCa were 47.7% (62/130 patients), 29.2% (38/130), and 52.3% (68/130), respectively. For csPCa, the CDRs of TB and CB according to PI-RADS categories of 3, 4, or 5 were 25.0% (8/32) and 31.3% (10/32), 41.2% (28/68) and 45.6% (31/68), or 86.7% (26/30) and 90.0% (27/30), respectively. In 6 (4.6%) patients, csPCa was detected only by SB. In 18 (13.8%) patients, SB detected PCa of a higher ISUP grade than TB. In 11 (8.5%) patients, SB detected csPCa at contralateral peripheral zone of TB.
Modified TRUS-guided 12-core CB using prebiopsy MRI seems to be feasible. It may reduce total biopsy cores in patients who are suitable for CB based on prebiopsy MRI findings.
本研究旨在分析经改良经直肠超声（TRUS）引导下使用前列腺影像报告和数据系统（PI-RADS）分类≥3 分的前列腺病变行 12 针改良靶向联合系统穿刺活检（CB）的诊断效能，以检测临床显著前列腺癌（csPCa）。
本回顾性研究纳入了 130 例连续接受改良经直肠超声引导下使用认知融合技术对 PI-RADS 分类≥3 分的前列腺病变行 12 针 CB 的患者。12 针 CB 包括 3-6 针靶向活检（TB）和系统活检（SB）。对于 SB，TB 区域的组织取样被省略，并且必须对 TB 的对侧外周区进行 3 针取样（即尖部、中部和基部）。csPCa 的定义为国际泌尿病理学会（ISUP）分级≥2 级的癌症。根据活检类型或 PI-RADS 分类，研究了每位患者的癌症检出率（CDR）。
TB、SB 和 CB 对 csPCa 的 CDR 分别为 47.7%（62/130 例患者）、29.2%（38/130 例患者）和 52.3%（68/130 例患者）。对于 csPCa，PI-RADS 分类为 3、4 或 5 的 TB 和 CB 的 CDR 分别为 25.0%（8/32 例）和 31.3%（10/32 例）、41.2%（28/68 例）和 45.6%（31/68 例）或 86.7%（26/30 例）和 90.0%（27/30 例）。在 6 例（4.6%）患者中，仅通过 SB 检测到 csPCa。在 18 例（13.8%）患者中，SB 检测到的 PCa 分级高于 TB。在 11 例（8.5%）患者中，SB 检测到 TB 对侧外周区的 csPCa。
经改良 TRUS 引导下使用前列腺 MRI 行 12 针 CB 似乎是可行的。它可以减少根据前列腺 MRI 结果适合 CB 的患者的总活检针数。
