St. John of God Hospital Vienna, Brothers of Mercy, Department of Urology Johannes-von-Gott-Platz 1, 1020 Vienna, Austria.
St. John of God Hospital Vienna, Brothers of Mercy, Department of Urology Johannes-von-Gott-Platz 1, 1020 Vienna, Austria; Paracelsus Medical University Salzburg, Department of Urology, Strubergasse 21, 5020 Salzburg, Austria.
Eur J Radiol. 2022 Sep;154:110432. doi: 10.1016/j.ejrad.2022.110432. Epub 2022 Jul 2.
The aim of this study was to compare cancer detection by targeted fusion-guided biopsy with systematic biopsy, and to evaluate the value of combined biopsy, in a daily clinical practice scenario. Furthermore, we aimed to assess the influence of previous biopsies on cancer detection.
In this retrospective single-centre study, we evaluated 524 cases of combined biopsy of the prostate from October 2015 to December 2018. All men had a clinical suspicion for prostate cancer due to an elevated PSA and/or a suspicious digital rectal examination and underwent a multiparametric MRI of the prostate read by one out of 6 experienced radiologists. In all cases, fusion-guided biopsy of the prostate was consecutively followed by systematic 12-core biopsy in the same session at the same urological department performed by one out of 5 experienced urologists.
In 270/524 (51.5%) cases, cancer was found using combined biopsy. Systematic biopsy alone detected cancer in 205/524 (39.1%) and clinically significant cancer in 137/524 (26.1%) cases. Fusion-guided biopsy alone detected 227/524 (43.3%) and clinically significant cancer in 150/524 (28.6%) cases. A histological upgrade of the Gleason score by fusion-guided biopsy was noted in 20/270 (7.4%) of all cancers found and by systematic biopsy in 31/270 (11.5%). Of all positive cases (clinically insignificant and significant cancer), 65/270 (24.1%) were detected only by fusion-guided biopsy, whereas 43/270 (15.9%) were detected only by systematic biopsy.
Fusion-guided biopsy can detect more cases of prostate cancers than systematic biopsy alone, especially clinically significant cancer. However, the combination of both biopsy methods improves the detection rate and can help to identify clinically significant cancer.
本研究旨在比较靶向融合引导活检与系统活检对前列腺癌的检出率，并评估联合活检的价值，同时评估既往活检对前列腺癌检出率的影响。
本回顾性单中心研究纳入了 2015 年 10 月至 2018 年 12 月期间 524 例接受前列腺融合引导联合系统活检的患者。所有患者均因 PSA 升高和/或直肠指检可疑而有前列腺癌临床可疑，且均接受了 6 位经验丰富的放射科医生之一阅读的多参数 MRI 前列腺检查。所有患者均在同一次就诊时在同一家泌尿外科由 5 位经验丰富的泌尿科医生之一进行前列腺融合引导活检，随后紧接着进行系统的 12 针活检。
在 524 例患者中，270 例（51.5%）通过联合活检发现了癌症。单纯系统活检检出癌症 205 例（39.1%）和临床显著癌症 137 例（26.1%）。单纯融合引导活检检出癌症 227 例（43.3%）和临床显著癌症 150 例（28.6%）。融合引导活检发现的所有癌症中有 20 例（7.4%）和系统活检发现的所有癌症中有 31 例（11.5%）出现了 Gleason 评分升级。在所有阳性病例（临床非显著和显著癌症）中，65 例（24.1%）仅通过融合引导活检检出，而 43 例（15.9%）仅通过系统活检检出。
融合引导活检比单纯系统活检能检出更多的前列腺癌病例，尤其是临床显著的癌症。然而，两种活检方法的联合应用可以提高检出率，并有助于发现临床显著的癌症。
