Department of Urology, University of Iowa, Iowa City, IA.
Carver College of Medicine, University of Iowa, Iowa City, IA.
Urol Oncol. 2022 Jan;40(1):7.e19-7.e24. doi: 10.1016/j.urolonc.2021.05.029. Epub 2021 Jun 27.
We hypothesized that the number of cores needed to detect prostate cancer would decrease with increasing MRI-targeted biopsy (TBx) experience.
All patients undergoing TBx at our institution from May 2017 to August 2019 were enrolled in a prospectively maintained database. Five biopsy cores were obtained from each lesion ≥3 on PI-RADS v2.0 followed by a systematic 12-core biopsy. To assess learning curve, the study population was divided into quartiles by sequential biopsies. Clinically significant prostate cancer (csPC) was defined as Gleason Grade Group 2 or higher.
377 patients underwent prostate biopsy (533 lesions); 233 lesions (44%) were positive for prostate cancer and 173 lesions (32%) were csPC. There was a significant decline in the number of cores required for diagnosing any cancer (P < 0.001) and csPC (P < 0.05) after the first quartile. There was no difference when stratifying by PI-RADS score or lesion volume. Within the first quartile, limiting the biopsy to 3 cores would miss 16.2% of csPC, decreasing to 6.6% after approximately 100 patients.
MRI TBx is associated with a learning curve of approximately 100 cases. Four or 5 cores should be considered during the initial experience, but thereafter, 3 cores per lesion is sufficient to detect csPC.
我们假设，随着 MRI 靶向活检（TBx）经验的增加，检测前列腺癌所需的核心数量将会减少。
我们机构于 2017 年 5 月至 2019 年 8 月期间进行 TBx 的所有患者均纳入前瞻性维护的数据库。每个 PI-RADS v2.0 评分≥3 的病变均获得 5 个活检核心，然后进行系统的 12 核活检。为了评估学习曲线，将研究人群按顺序活检分为四等份。临床显著前列腺癌（csPC）定义为 Gleason 分级组 2 或更高。
377 名患者接受了前列腺活检（533 个病灶）；233 个病灶（44%）为前列腺癌阳性，173 个病灶（32%）为 csPC。在第一个四分位数后，诊断任何癌症（P<0.001）和 csPC（P<0.05）所需的核心数量显著下降。按 PI-RADS 评分或病变体积分层时无差异。在第一个四分位数内，将活检限制在 3 个核心会错过 16.2%的 csPC，大约 100 例后降至 6.6%。
MRI-TBx 与大约 100 例的学习曲线相关。在初始经验中应考虑使用 4 或 5 个核心，但此后，每个病变 3 个核心足以检测 csPC。
