Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
World J Urol. 2022 Nov;40(11):2683-2688. doi: 10.1007/s00345-022-04155-4. Epub 2022 Sep 23.
We hypothesized that systematic biopsies (SBx) value for clinically significant PCa (csPCa) detection, in addition to mpMRI targeted biopsies (TBx), may vary significantly according to mpMRI index lesion (IL) characteristics.
We identified 1350 men with an mpMRI suspicious lesion (PI-RADS ≥ 3), defined as IL, who underwent TBx and SBx at three referral centres. The outcome was SBx added value in csPCa (grade group ≥ 2 PCa detected at SBx and missed by TBx) detection. To this aim, we performed multivariable logistic regression analyses (MVA). Furthermore, we explored the interaction between IL volume and SBx csPCa added value, across different PI-RADS categories, using lowess function.
Overall, 569 (42%) men had csPCa at TBx and 78 (6%) csPCa were identified at SBx only. At MVA PSA (OR 0.90; p < 0.05) and IL volume (OR 0.58; p < 0.05) were associated with SBx csPCa added value. At interaction analyses, a nonlinear correlation between PI-RADS and SBx csPCa added value was identified with a decrease from roughly 10 to 4% followed by a substantial plateau at 1.2 ml and 0.6 ml for PI-RADS 3 and 4, respectively. For PI-RADS 5 lesions SBx csPCa added was constantly lower than 4%.
Increasing IL volume in PI-RADS 3 and 4 lesions is associated with reduction in SBx csPCa added value. For diagnostic purposes, SBx could be omitted in men with IL larger than 1.2 ml and 0.6 ml for PI-RADS 3 and 4, respectively. Conversely, for PI-RADS 5, SBx csPCa added value was minimal regardless of IL volume.
我们假设系统活检（SBx）在检测临床显著前列腺癌（csPCa）方面的价值，除了 mpMRI 靶向活检（TBx）外，还可能根据 mpMRI 指数病变（IL）的特征而显著不同。
我们在三个转诊中心共确定了 1350 名 mpMRI 可疑病变（PI-RADS≥3）患者，将其定义为 IL，这些患者接受了 TBx 和 SBx。研究结果为 SBx 在 csPCa（在 SBx 中检测到的分级组≥2 的 PCa，而在 TBx 中漏诊）检测中的附加价值。为此，我们进行了多变量逻辑回归分析（MVA）。此外，我们使用低通函数探索了 IL 体积与 SBx csPCa 附加价值之间的相互作用，跨越了不同的 PI-RADS 类别。
总体而言，569 名（42%）男性在 TBx 时患有 csPCa，78 名（6%）男性仅在 SBx 时患有 csPCa。在 MVA 中，PSA（OR 0.90；p<0.05）和 IL 体积（OR 0.58；p<0.05）与 SBx csPCa 附加价值相关。在交互分析中，发现 PI-RADS 与 SBx csPCa 附加价值之间存在非线性相关性，从大约 10%降至 4%，然后在 PI-RADS 3 和 4 分别为 1.2ml 和 0.6ml 时出现大幅平台期。对于 PI-RADS 5 病变，SBx csPCa 附加价值始终低于 4%。
PI-RADS 3 和 4 病变中 IL 体积的增加与 SBx csPCa 附加价值的降低相关。对于诊断目的，如果 IL 分别大于 PI-RADS 3 和 4 的 1.2ml 和 0.6ml，则可以省略男性的 SBx。相反，对于 PI-RADS 5，无论 IL 体积如何，SBx csPCa 附加价值都很小。
