Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Department of Urology and Urosurgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
World J Urol. 2022 Feb;40(2):427-433. doi: 10.1007/s00345-021-03891-3. Epub 2021 Nov 26.
Magnetic resonance imaging (MRI)/ultrasound-fusion prostate biopsy (FB) comprises multiple steps each of which can cause alterations in targeted biopsy (TB) accuracy leading to false-negative results. The aim was to assess the inter-operator variability of software-based fusion TB by targeting the same MRI-lesions by different urologists.
In this prospective study, 142 patients eligible for analysis underwent software-based FB. TB of all lesions (n = 172) were carried out by two different urologists per patient (n = 31 urologists). We analyzed the number of mismatches [overall prostate cancer (PCa), clinically significant PCa (csPCa) and non-significant PCa (nsPCa)] between both performed TB per patient. In addition we evaluated factors contributing to inter-operator variability by uni- and multivariable analyses.
In 11.6% of all MRI-lesions (10.6% of all patients) there was a mismatch between TB1 and TB2 in terms of overall prostate cancer (PCa detection. Regarding csPCa, patient-based mismatch occurred in 14.8% (n = 21). Overall PCa and csPCa detection rate of TB1 and TB2 did not differ significantly on a per-patient and per-lesion level. Analyses revealed a smaller lesion size as predictive for mismatches (OR 9.19, 95% CI 2.02-41.83, p < 0.001).
Reproducibility and precision of targeting particularly small lesions is still limited although using software-based FB. Further improvements in image-fusion, segmentation, needle-guidance, and automatization are necessary.
磁共振成像（MRI）/超声融合前列腺活检（FB）由多个步骤组成，每个步骤都可能导致靶向活检（TB）准确性发生变化，导致假阴性结果。目的是评估不同泌尿科医生对基于软件的融合 TB 的操作者间变异性。
在这项前瞻性研究中，符合分析条件的 142 名患者接受了基于软件的 FB。每位患者（n=31 位泌尿科医生）的所有病变（n=172）的 TB 均由两位不同的泌尿科医生进行。我们分析了每位患者两次 TB 之间的不匹配病变数量[总体前列腺癌（PCa）、临床显著 PCa（csPCa）和非显著 PCa（nsPCa）]。此外，我们通过单变量和多变量分析评估了导致操作者间变异性的因素。
在所有 MRI 病变的 11.6%（所有患者的 10.6%）中，TB1 和 TB2 在总体 PCa 检测方面存在不匹配。在 csPCa 方面，患者基础上的不匹配发生率为 14.8%（n=21）。TB1 和 TB2 的总体 PCa 和 csPCa 检测率在患者和病变水平上没有显著差异。分析显示，病变较小是导致不匹配的预测因素（OR 9.19，95%CI 2.02-41.83，p<0.001）。
尽管使用基于软件的 FB，但针对特别是小病变的可重复性和精度仍然有限。需要进一步改进图像融合、分割、针引导和自动化。
