Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
Prostate Cancer Prostatic Dis. 2023 Sep;26(3):575-580. doi: 10.1038/s41391-022-00620-8. Epub 2022 Dec 12.
The added-value of systematic biopsy (SB) in patients undergoing magnetic resonance imaging (MRI)-targeted biopsy (TB) remains unclear and the spatial distribution of positive cores relative to the MRI lesion has been poorly studied. The aim of this study was to determine the utility of perilesional biopsy in detecting clinically significant prostate cancer (csPCa).
We enrolled 505 consecutive patients that underwent SB and TB for suspicious MRI lesions (PI-RADS score 3-5) at Jules Bordet Institute between June 2016 and January 2022. Patient-specific tridimensional prostate maps were reviewed to determine the distance between systematic cores containing csPCa and the MRI index lesion. Primary outcomes were the cancer detection rate (CDR) per patient and the cumulative cancer distribution rate of positive cores for each 5 mm interval from the MRI index lesion. The secondary outcome was the identification of risk groups for the presence of csPCa beyond a 10 mm margin using the chi-square automated interaction detector (CHAID) machine learning algorithm.
Overall, the CDR for csPCa of TB, SB, and combined method were 32%, 25%, and 37%, respectively. While combined method detected more csPCa compared to TB (37% vs. 32%, p < 0.001), no difference was found when TB was associated with perilesional sampling within 10 mm (37% vs. 35%, p = 0.2). The cumulative cancer distribution rate for csPCa reached 86% for the 10 mm margin. The CHAID algorithm identified three risk groups: (1) PI-RADS3 ("low-risk"), (2) PI-RADS4 or PI-RADS5 and PSA density <0.15 ng/ml ("intermediate-risk"), and (3) PI-RADS 5 and PSA density ≥0.15 ng/ml ("high-risk"). The risk of missing csPCa was 2%, 8%, and 29% for low-, intermediate- and high-risk groups, respectively. Avoiding biopsies beyond a 10 mm margin prevented the detection of 19% of non-csPCa.
Perilesional biopsy template using a 10 mm margin seems a reasonable alternative to the combined method with a comparable detection of csPCa. Our risk stratification may further enhance the selection of patients.
在接受磁共振成像引导靶向活检（MRI-TB）的患者中，系统活检（SB）的附加价值仍不清楚，且阳性核心相对于 MRI 病变的空间分布也研究甚少。本研究旨在确定周围活检在检测临床显著前列腺癌（csPCa）中的作用。
我们纳入了 2016 年 6 月至 2022 年 1 月在 Jules Bordet 研究所因可疑 MRI 病变（PI-RADS 评分 3-5）接受 SB 和 TB 的 505 例连续患者。对患者特定的三维前列腺图谱进行了回顾，以确定包含 csPCa 的系统核心与 MRI 指数病变之间的距离。主要结局为每位患者的癌症检出率（CDR）和 MRI 指数病变每 5mm 间隔处阳性核心的累积癌症分布率。次要结局是使用卡方自动交互检测（CHAID）机器学习算法确定 10mm 以外存在 csPCa 的风险组。
总体而言，TB、SB 和联合方法的 csPCa 检出率分别为 32%、25%和 37%。尽管联合方法比 TB 检测到更多的 csPCa（37%比 32%，p<0.001），但当 TB 与 10mm 以内的周围取样相结合时，差异无统计学意义（37%比 35%，p=0.2）。csPCa 的累积癌症分布率在 10mm 边界处达到 86%。CHAID 算法确定了三个风险组：（1）PI-RADS3（“低危”）；（2）PI-RADS4 或 PI-RADS5 且 PSA 密度<0.15ng/ml（“中危”）；（3）PI-RADS 5 且 PSA 密度≥0.15ng/ml（“高危”）。低危、中危和高危组错过 csPCa 的风险分别为 2%、8%和 29%。避免 10mm 以外的活检可防止漏诊 19%的非 csPCa。
使用 10mm 边界的周围活检模板似乎是联合方法的合理替代方案，具有相当的 csPCa 检出率。我们的风险分层可能进一步增强患者的选择。
