Jager Auke, van Riel Luigi A M J G, Postema Arnoud W, de Reijke Theo M, van der Sluis Tim M, Oddens Jorg R
Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Free University, Amsterdam, The Netherlands.
Ther Adv Urol. 2022 Jul 26;14:17562872221111410. doi: 10.1177/17562872221111410. eCollection 2022 Jan-Dec.
The introduction of magnetic resonance imaging (MRI)-targeted biopsy (TBx) besides systematic prostate biopsies has resulted in a discussion on what the optimal prostate biopsy strategy is. The ideal template has high sensitivity for clinically significant prostate cancer (csPCa), while reducing the detection rate of clinically insignificant prostate cancer (iPCa). This study evaluates different biopsy strategies in patients with a unilateral prostate MRI lesion.
Retrospective subgroup analysis of a prospectively managed database consisting of patients undergoing prostate biopsy in two academic centres. Patients with a unilateral lesion (PI-RADS ⩾ 3) on MRI were included for analysis. The primary objective was to evaluate the diagnostic performance for different biopsy approaches compared with bilateral systematic prostate biopsy (SBx) and TBx. Detection rates for csPCa (ISUP ⩾ 2), adjusted csPCa (ISUP ⩾ 3) and iPCa (ISUP = 1) were determined for SBx alone, TBx alone, contralateral SBx combined with TBx and ipsilateral SBx combined with TBx. A subgroup analysis was performed for biopsy-naive patients.
A total of 228 patients were included from October 2015 to September 2021. Prostate cancer (PCa) detection rate of combined SBx and TBx was 63.5% for csPCa, 35.5% for adjusted csPCa, and 14% for iPCa. The best performing alternative biopsy strategy was TBx and ipsilateral SBx, which reached a sensitivity of 98.6% (95% CI: 95.1-99.6) for csPCa and 98.8% (95% CI: 96.3-99.9) for adjusted csPCa, missing only 1.4% of csPCa, while reducing iPCa detection by 15.6% compared with SBx and TBx. TBx or SBx alone missed a significant amount of csPCa, with sensitivities of 90.3% (95% CI: 84.4-94.2) and 86.8% (95% CI: 80.4-91.4) for csPCa. Subgroup analysis on biopsy-naive patients showed similar results as the overall group.
This study shows that performing TBx with ipsilateral SBx and omitting contralateral SBx is the optimal biopsy strategy in patients with a unilateral MRI lesion. With this strategy, a very limited amount of csPCa is missed and iPCa detection is reduced.
除了系统性前列腺活检外，磁共振成像（MRI）靶向活检（TBx）的引入引发了关于最佳前列腺活检策略的讨论。理想的活检模板对临床显著前列腺癌（csPCa）具有高敏感性，同时降低临床意义不显著前列腺癌（iPCa）的检出率。本研究评估单侧前列腺MRI病变患者的不同活检策略。
对两个学术中心接受前列腺活检患者的前瞻性管理数据库进行回顾性亚组分析。纳入MRI上有单侧病变（PI-RADS⩾3）的患者进行分析。主要目的是评估与双侧系统性前列腺活检（SBx）和TBx相比，不同活检方法的诊断性能。确定单独SBx、单独TBx、对侧SBx联合TBx以及同侧SBx联合TBx的csPCa（ISUP⩾2）、校正后csPCa（ISUP⩾3）和iPCa（ISUP = 1）的检出率。对未接受过活检的患者进行亚组分析。
2015年10月至2021年9月共纳入228例患者。联合SBx和TBx的前列腺癌（PCa）检出率为：csPCa为63.5%，校正后csPCa为35.5%，iPCa为14%。表现最佳的替代活检策略是TBx和同侧SBx，其对csPCa的敏感性达到98.6%（95%CI：95.1 - 99.6），对校正后csPCa的敏感性达到98.8%（95%CI：96.3 - 99.9），仅漏诊1.4%的csPCa，同时与SBx和TBx相比，iPCa检出率降低15.6%。单独的TBx或SBx漏诊了大量的csPCa，csPCa的敏感性分别为90.3%（95%CI：84.4 - 94.2）和86.8%（95%CI：80.4 - 91.4）。对未接受过活检患者的亚组分析结果与总体组相似。
本研究表明，对于单侧MRI病变患者，采用同侧SBx联合TBx并省略对侧SBx是最佳活检策略。采用该策略，漏诊的csPCa数量非常有限，且iPCa检出率降低。
