微超声与多参数 MRI 检测前列腺癌的比较：在未经活检的男性中的应用。
Comparison of Micro-US and Multiparametric MRI for Prostate Cancer Detection in Biopsy-Naive Men.
机构信息
From the Joint Department of Medical Imaging, University Health Network-Sinai Health System-Women's, College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., H.F., M.A.H.); Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada (N.P., S.J., K.C., K.L., A.R.Z., A.F.); Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada (C.A., T.H.v.d.K.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada (K.L.); Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.); and Department of Surgery, University of Toronto, Toronto, Canada (U.J.).
出版信息
Radiology. 2022 Nov;305(2):390-398. doi: 10.1148/radiol.212163. Epub 2022 Jul 19.
Background Multiparametric MRI has led to increased detection of clinically significant prostate cancer (csPCa). Micro-US is being investigated for csPCa detection. Purpose To compare multiparametric MRI and micro-US in detecting csPCa (grade group ≥2) and to determine the proportion of MRI nodules visible at micro-US for real-time targeted biopsy. Materials and methods This prospective, single-center trial enrolled biopsy-naive men with suspected prostate cancer (PCa) between May 2019 and September 2020. All patients underwent multiparametric MRI followed by micro-US; findings at both were interpreted in a blinded fashion, followed by targeted biopsy and nontargeted systematic biopsy using micro-US. Proportions were compared using the exact McNemar test. The differences in proportions were calculated. Results Ninety-four men (median age, 61 years; IQR, 57-68 years) were included. MRI- and micro-US-targeted biopsy depicted csPCa in 37 (39%) and 33 (35%) of the 94 men, respectively ( = .22); clinically insignificant PCa in 14 (15%) and 15 (16%) ( > .99); and cribriform and/or intraductal PCa in 14 (15%) and 13 (14%) ( > .99). The MRI- plus micro-US-targeted biopsy pathway depicted csPCa in 38 of the 94 (40%) men. The addition of nontargeted systematic biopsy to MRI- plus micro-US-targeted biopsy did not enable identification of any additional men with csPCa but did help identify nine additional men with clinically insignificant PCa ( = .04). Biopsy was avoided in 32 of the 94 men (34%) with MRI and nine of the 94 men (10%) with micro-US ( < .001). Among 93 MRI targets, 62 (67%) were prospectively visible at micro-US. Conclusion MRI and micro-US showed similar rates of prostate cancer detection, but more biopsies were avoided with the MRI pathway than with micro-US, with no benefit of adding nontargeted systematic biopsy to the MRI- plus micro-US-targeted biopsy pathway. Most MRI lesions were prospectively visible at micro-US, allowing real-time targeted biopsy. ClinicalTrials.gov registration no.: NCT03938376 © RSNA, 2022
背景 多参数 MRI 提高了临床显著前列腺癌（csPCa）的检出率。微超声（micro-US）正被用于 csPCa 的检测。目的 比较多参数 MRI 和 micro-US 在检测 csPCa（分级组≥2）方面的性能，并确定 MRI 结节在 micro-US 下实时靶向活检的可见比例。
材料与方法 本前瞻性、单中心研究纳入了 2019 年 5 月至 2020 年 9 月间疑似前列腺癌（PCa）的活检初筛阴性男性。所有患者均行多参数 MRI 检查，然后行 micro-US 检查；MRI 和 micro-US 检查结果均以盲法进行解读，然后行 MRI 和 micro-US 引导的靶向活检和非靶向系统活检。采用确切 McNemar 检验比较比例，计算比例差异。
结果 94 例男性纳入研究（中位年龄 61 岁，IQR：57-68 岁）。MRI 和 micro-US 靶向活检分别检出 37 例（39%）和 33 例（35%）的 csPCa（ =.22），检出 14 例（15%）和 15 例（16%）的临床意义不显著 PCa（ >.99），检出 14 例（15%）和 13 例（14%）的筛状和/或管内 PCa（ >.99）。MRI 和 micro-US 靶向活检联合检出 38 例（40%）csPCa。在 MRI 和 micro-US 靶向活检联合的基础上增加非靶向系统活检未能检出更多 csPCa，但确实检出了 9 例临床意义不显著的 PCa（ =.04）。94 例男性中，32 例（34%）行 MRI 检查，9 例（10%）行 micro-US 检查，均避免了活检（ <.001）。93 个 MRI 靶标中，62 个（67%）在 micro-US 下可预期显示。
结论 MRI 和 micro-US 检出前列腺癌的检出率相似，但 MRI 途径的活检数量减少，与 micro-US 相比，避免了更多的活检，而在 MRI 和 micro-US 靶向活检联合的基础上增加非靶向系统活检并无获益。大多数 MRI 病变在 micro-US 下可预期显示，从而可实时行靶向活检。
临床试验注册
NCT03938376
© 2022 RSNA
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