Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
BMC Urol. 2022 May 6;22(1):74. doi: 10.1186/s12894-022-01021-8.
To investigate the causes of missed diagnosis in mpMRI/TRUS fusion-guided targeted prostate biopsy.
The clinical data of 759 patients who underwent transperineal prostate biopsy from March 2021 to June 2021 at Nanjing DrumTower Hospital were retrospectively analyzed. Twenty-one patients had MRI contraindications. Ultimately, 738 patients completed mpMRI/TRUS fusion-guided targeted prostate biopsy + 12-core transperineal systematic biopsy after mpMRI and PI-RADS scoring. The pathological diagnoses from targeted and systematic biopsy were compared to evaluate and analyze the reasons for missed diagnoses in targeted biopsy.
A total of 388 prostate cancer patients were identified, including 37 (9%) missed diagnoses with targeted biopsy and 44 (11.34%) with systematic biopsy. Between the target biopsy missed diagnosis group and not missed diagnosis group, there was no significant difference in age (71.08 ± 7.11 vs. 71.80 ± 7.94), but PSA (13.63 ± 12.41 vs. 54.54 ± 177.25 ng/ml), prostate volume (61.82 ± 40.64 vs. 44.34 ± 25.07 cm), PSAD (0.27 ± 0.28 vs. 1.07 ± 2.91), and ISUP grade [1(1) vs. 3(2)] were significantly different. The pathological results of the 37 targeted biopsy missed diagnoses were recompared with MRI: 21 prostate cancers were normal on MRI; 9 cancer areas were abnormal on MRI; and 7 cancer areas on MRI were PI-RADS 3.
Early prostate cancer, large prostate, effect of local anesthesia, doctor-patient cooperation, MRI diagnosis, and operator technology were possible factors for missed diagnosis in targeted biopsy. Improvements imaging technology, greater experience, and personalized biopsy may lead to an accurate pathological diagnosis.
探讨磁共振成像（MRI）-超声融合引导靶向前列腺穿刺活检漏诊的原因。
回顾性分析 2021 年 3 月至 2021 年 6 月在南京鼓楼医院行经会阴前列腺穿刺活检的 759 例患者的临床资料。21 例患者 MRI 禁忌。最终，738 例患者在 MRI 及 PI-RADS 评分后完成 MRI-超声融合引导靶向前列腺穿刺活检+12 针经会阴系统穿刺活检。比较靶向和系统穿刺活检的病理诊断，评估和分析靶向活检漏诊的原因。
共发现 388 例前列腺癌患者，其中靶向活检漏诊 37 例（9%），系统活检漏诊 44 例（11.34%）。在靶向活检漏诊组和非漏诊组之间，年龄（71.08±7.11 岁比 71.80±7.94 岁）无显著差异，但 PSA（13.63±12.41ng/ml 比 54.54±177.25ng/ml）、前列腺体积（61.82±40.64cm3 比 44.34±25.07cm3）、PSAD（0.27±0.28ng/ml 比 1.07±2.91ng/ml2）和 ISUP 分级[1（1）比 3（2）]有显著差异。37 例靶向活检漏诊患者的病理结果与 MRI 再次比较：21 例 MRI 正常；9 例 MRI 癌灶异常；7 例 MRI 癌灶 PI-RADS 分级 3 分。
早期前列腺癌、前列腺体积大、局部麻醉效果、医患配合、MRI 诊断、操作者技术可能是靶向活检漏诊的原因。提高影像技术、丰富经验、个性化活检可能有助于准确的病理诊断。
