MRI/经直肠超声融合引导靶向活检与经直肠超声引导系统活检用于前列腺癌诊断：一项系统评价与Meta分析

MRI/Transrectal Ultrasound Fusion-Guided Targeted Biopsy and Transrectal Ultrasound-Guided Systematic Biopsy for Diagnosis of Prostate Cancer: A Systematic Review and Meta-analysis.

作者信息

Xie Jianfeng, Jin Chunchun, Liu Mengmeng, Sun Kun, Jin Zhanqiang, Ding Zhimin, Gong Xuehao

机构信息

Department of Ultrasound, Southern University of Science and Technology Hospital, Shenzhen, China.

Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.

出版信息

Front Oncol. 2022 May 23;12:880336. doi: 10.3389/fonc.2022.880336. eCollection 2022.

PURPOSE

For men suspected of having prostate cancer (PCa), the transrectal ultrasound (TRUS)-guided systematic biopsy (SB) was performed. MRI/TRUS fusion guided-targeted biopsy (MRI-TB) could enhance PCa detection, allowing sampling of sites at higher risk which were not obvious with TRUS alone. The aim of this systematic review and meta-analysis was to compare the detection rates of prostate cancer by MRI-TB or MRI-TB plus SB versus SB, mainly for diagnosis of high-risk PCa.

METHODS

A literature Search was performed on PubMed, Cochrane Library, and Embase databases. We searched from inception of the databases up to January 2021.

RESULTS

A total of 5831 patients from 26 studies were included in the present meta-analysis. Compared to traditional TRUS-guided biopsy, MRI-TB had a significantly higher detection rate of clinically significant PCa (RR=1.27; 95%CI 1.15-1.40; p<0.001) and high-risk PCa (RR=1.41; 95% CI 1.22-1.64; p<0.001), while the detection rate of clinically insignificant PCa was lower (RR=0.65; 95%CI 0.55-0.77; p<0.001). MRI-TB and SB did not significantly differ in the detection of overall prostate cancer (RR=1.04; 95%CI 0.95-1.12; p=0.41). Compared with SB alone, we found that MRI-TB plus SB diagnosed more cases of overall, clinically significant and high-risk PCa (p<0.001).

CONCLUSION

Compared with systematic protocols, MRI-TB detects more clinically significant and high-risk PCa cases, and fewer clinically insignificant PCa cases. MRI-TB combined with SB enhances PCa detection in contrast with either alone but did not reduce the diagnosis rate of clinically insignificant PCa.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/#searchadvanced, CRD42021218475.

目的

对于疑似患有前列腺癌（PCa）的男性，进行了经直肠超声（TRUS）引导下的系统活检（SB）。MRI/TRUS融合引导靶向活检（MRI-TB）可提高PCa的检出率，能够对单独TRUS检查时不明显的高风险部位进行采样。本系统评价和荟萃分析的目的是比较MRI-TB或MRI-TB联合SB与SB对前列腺癌的检出率，主要用于高危PCa的诊断。

方法

在PubMed、Cochrane图书馆和Embase数据库中进行文献检索。我们检索了从数据库建立到2021年1月的文献。

结果

本荟萃分析共纳入了26项研究中的5831例患者。与传统的TRUS引导活检相比，MRI-TB对临床显著PCa（RR = 1.27；95%CI 1.15 - 1.40；p < 0.001）和高危PCa（RR = 1.41；95%CI 1.22 - 1.64；p < 0.001）的检出率显著更高，而对临床意义不显著的PCa的检出率较低（RR = 0.65；95%CI 0.55 - 0.77；p < 0.001）。MRI-TB和SB在总体前列腺癌的检出率上无显著差异（RR = 1.04；95%CI 0.95 - 1.12；p = 0.41）。与单独的SB相比，我们发现MRI-TB联合SB诊断出的总体、临床显著和高危PCa病例更多（p < 0.001）。