Hayes Mitch, Bassale Solange, Chakiryan Nicholas H, Boileau Luc, Grassauer Jacob, Wagner Matthew, Foster Bryan, Coakley Fergus, Isharwal Sudhir, Amling Christopher L, Liu Jen-Jane
Department of Urology Oregon Health & Science University Portland Oregon USA.
Knight Cancer Institute, Biostatistics Shared Resources Oregon Health and Science University Portland Oregon USA.
BJUI Compass. 2022 Jun 5;3(6):443-449. doi: 10.1002/bco2.172. eCollection 2022 Nov.
To compare overall agreement between magnetic resonance imaging (MRI)-ultrasound (US) fusion biopsy (FB) and MRI cognitive fusion biopsy (CB) of the prostate and determine which factors affect agreement for prostate cancer (PCa) who underwent both modalities in a prospective within-patient protocol.
From August 2017 to January 2021, patients with at least one Prostate Imaging Reporting & Data System (PI-RADS) 3 or higher lesion on multiparametric MRI underwent transrectal FB and CB in a prospective within-patient protocol. CB was performed for each region of interest (ROI), followed by FB, followed by standard 12 core biopsy. Patients who were not on active surveillance were analysed. The primary endpoint was agreement for any PCa detection. McNemar's test and kappa statistic were used to analyse agreement. Chi-square test, Fisher's exact test and Wilcoxon rank sum test were used to analyse disagreement across clinical and MRI spatial variables. A multivariable generalized mixed-effect model was used to compare the interaction between select variables and fusion modality. Statistics were performed using SAS and R.
Ninety patients and 98 lesions were included in the analysis. There was moderate agreement between FB and CB ( = 0.715). McNemar's test was insignificant ( = 0.285). Anterior location was the only variable associated with a significant variation in agreement, which was 70% for anterior lesions versus 89.7% for non-anterior lesions ( = 0.035). Discordance did not vary significantly across other variables. In a mixed-effect model, the interaction between anterior location and use of FB was insignificant ( = 0.411).
In a within-patient protocol of patients not on active surveillance, FB and CB performed similarly for PCa detection and with moderate agreement. Anterior location was associated with significantly higher disagreement, whereas other patient and lesion characteristics were not. Additional studies are needed to determine optimal biopsy technique for sampling anterior ROI.
比较前列腺磁共振成像（MRI）-超声（US）融合活检（FB）与MRI认知融合活检（CB）之间的总体一致性，并确定在一项前瞻性患者内方案中接受两种检查方式的前列腺癌（PCa）患者中，哪些因素会影响一致性。
2017年8月至2021年1月，在一项前瞻性患者内方案中，对多参数MRI上至少有一个前列腺影像报告和数据系统（PI-RADS）3级或更高病变的患者进行经直肠FB和CB。对每个感兴趣区域（ROI）进行CB，然后进行FB，接着进行标准的12针活检。对未进行主动监测的患者进行分析。主要终点是任何PCa检测的一致性。采用McNemar检验和kappa统计量分析一致性。采用卡方检验、Fisher精确检验和Wilcoxon秩和检验分析临床和MRI空间变量之间的不一致性。使用多变量广义混合效应模型比较选定变量与融合方式之间的相互作用。使用SAS和R进行统计分析。
90例患者和98个病变纳入分析。FB和CB之间存在中度一致性（κ = 0.715）。McNemar检验无统计学意义（P = 0.285）。前部位置是与一致性显著差异相关的唯一变量，前部病变的一致性为70%，而非前部病变为89.7%（P = 0.035）。其他变量的不一致性无显著差异。在混合效应模型中，前部位置与FB使用之间的相互作用无统计学意义（P = 0.411）。
在未进行主动监测的患者内方案中，FB和CB在PCa检测方面表现相似，一致性为中度。前部位置与显著更高的不一致性相关，而其他患者和病变特征则不然。需要进一步研究以确定对前部ROI进行采样的最佳活检技术。
