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对 MRI/超声融合活检阴性的 PI-RADS 4/5 病变男性进行随访。

Follow-up of men with a PI-RADS 4/5 lesion after negative MRI/Ultrasound fusion biopsy.

机构信息

Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany.

Department of Urology, Vivantes Am Urban, Berlin, Germany.

出版信息

Sci Rep. 2022 Aug 10;12(1):13603. doi: 10.1038/s41598-022-17260-6.

DOI:10.1038/s41598-022-17260-6
PMID:35948575
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9365776/
Abstract

Magnetic resonance imaging/Ultrasound (MRI/US) fusion targeted biopsy (TB) in combination with a systematic biopsy (SB) improves cancer detection but limited data is available how to manage patients with a Prostate Imaging-Reporting and Data System (PI-RADS) ≥ 4 lesion and a negative biopsy. We evaluate the real-world management and the rate of clinically significant Prostate Cancer (csPCa) during follow-up. 1546 patients with a multi-parametric MRI (mpMRI) and a PI-RADS ≥ 3 who underwent SB and TB between January 2012 and May 2017 were retrospectively analyzed. 222 men with a PI-RADS ≥ 4 and a negative biopsy were included until 2019. For 177/222 (80%) complete follow-up data was obtained. 66/84 (78%) had an initial PI-RADS 4 and 18 (22%) a PI-RADS 5 lesion. 48% (84/177) received a repeat mpMRI; in the follow-up mpMRI, 39/84 (46%) lesions were downgraded to PI-RADS 2 and 11 (13%) to PI-RADS 3; three cases were upgraded and 28 lesions remained consistent. 18% (32/177) men underwent repeated TB and csPCa was detected in 44% (14/32). Our study presents real world data on the management of men with a negative TB biopsy. Men with a positive mpMRI and lesions with high suspicion (PI-RADS4/5) and a negative targeted biopsy should be critically reviewed and considered for repeat biopsy or strict surveillance. The optimal clinical risk assessment remains to be further evaluated.

摘要

磁共振成像/超声（MRI/US）融合靶向活检（TB）联合系统活检（SB）可提高癌症检出率，但关于如何管理前列腺成像报告和数据系统（PI-RADS）≥4 病变且活检阴性的患者，目前仅有有限的数据。我们评估了真实世界中这些患者的管理方式，以及在随访期间临床显著前列腺癌（csPCa）的发生率。

回顾性分析了 2012 年 1 月至 2017 年 5 月间接受 SB 和 TB 的多参数 MRI（mpMRI）且 PI-RADS≥3 的 1546 例患者，其中 222 例 PI-RADS≥4 且活检阴性的患者被纳入研究，直至 2019 年。177 例患者中，177 例（80%）有完整的随访数据。84 例患者初始 PI-RADS 为 4，18 例患者初始 PI-RADS 为 5。48%（84/177）接受了重复 mpMRI；在随访 mpMRI 中，39 例（46%）病变降为 PI-RADS 2，11 例（13%）降为 PI-RADS 3，3 例升为 PI-RADS 4，28 例病变保持不变。18%（32/177）的患者接受了重复 TB，其中 44%（14/32）发现了 csPCa。

本研究提供了阴性 TB 活检患者管理的真实世界数据。对于 mpMRI 阳性、病变高度可疑（PI-RADS4/5）且 TB 阴性的患者，应进行仔细评估，考虑重复活检或严格监测。最佳临床风险评估仍有待进一步评估。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5885/9365776/71020993be27/41598_2022_17260_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5885/9365776/cfe3f2caa1e4/41598_2022_17260_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5885/9365776/adb235fb7707/41598_2022_17260_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5885/9365776/71020993be27/41598_2022_17260_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5885/9365776/cfe3f2caa1e4/41598_2022_17260_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5885/9365776/adb235fb7707/41598_2022_17260_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5885/9365776/71020993be27/41598_2022_17260_Fig3_HTML.jpg

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