对前列腺癌患者经系统活检和MRI/超声融合靶向活检评估的分级组与根治性前列腺切除术标本进行直接比较。
Direct comparison between Grade Group assessed on systematic and MRI/ultrasound fusion targeted biopsies correlated to the radical prostatectomy specimens in patients with prostate cancer.
作者信息
Payrard-Starck C, Fourcade A, An Nguyen T, Tissot V, Doucet L, Marolleau J, Lucas C, Fournier G, Valeri A
机构信息
Urology Department, CHU Brest, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Brest, Brest, France.
Urology Department, CHU Brest, Brest, France.
出版信息
Prog Urol. 2023 Apr;33(5):265-271. doi: 10.1016/j.purol.2023.01.004. Epub 2023 Feb 4.
OBJECTIVES
To compare the correlation of Gleason score (GS) and ISUP grade determined by prostate biopsies (PBx) and radical prostatectomy (RP) specimens according to the biopsy technique: ultrasound randomised (RBx) vs. MRI/ultrasound fusion targeted (TBx).
MATERIALS AND METHODS
Between March 2013 and June 2018, we retrospectively included patients who underwent RP for prostate cancer (PCa) histopathologically proven by RBx and/or TBx. All patients had a prebiopsy MRI by a single radiologist (using PI-RADS score), then transrectal RBx (12cores, blinded to MRI lesions) and TBx (2-4 cores/target) with elastic MRI/ultrasound fusion (UroStation™, Koelis, Grenoble, France). Histological findings were compared: PBx vs. RP.
RESULTS
One hundred and four patients underwent RP after RBx and/or TBx. ISUP concordance rate was better with the association RBx+TBx 49% (51/104) vs. 43.3% with TBx (P=0.07) and 43.3% with RBx (P=0.13). With RBx, 50% of the patients were downgraded (52/104) against 42.3% (44/104) with TBx (P=0.088). The association RBx+TBx significantly decreased the rate of downgrading of the ISUP score compared to the ISUP score of RP 35.6% (37/104) vs. RBx (50%, P=0.0001) and vs. TBx (42.3%, P=0.016).
CONCLUSION
In half of cases, the ISUP score was underestimated in RBx compared to RP specimens. Adding TBx to RBx significantly reduced downgrading. The combination of both biopsy techniques appeared to be the best protocol to get closer to ISUP score and GS of the RP specimens.
LEVEL OF EVIDENCE
C.
目的
根据活检技术（超声随机活检[RBx]与磁共振成像/超声融合靶向活检[TBx]），比较前列腺活检（PBx）和根治性前列腺切除术（RP）标本所确定的Gleason评分（GS）与国际泌尿病理学会（ISUP）分级之间的相关性。
材料与方法
在2013年3月至2018年6月期间，我们回顾性纳入了经RBx和/或TBx组织病理学证实为前列腺癌（PCa）并接受RP的患者。所有患者均由一名放射科医生进行活检前磁共振成像检查（使用前列腺影像报告和数据系统[PI-RADS]评分），然后进行经直肠RBx（12针，对磁共振成像病变不知情）和TBx（每个靶点2 - 4针），采用弹性磁共振成像/超声融合技术（UroStation™，Koelis，法国格勒诺布尔）。比较组织学检查结果：PBx与RP。
结果
104例患者在RBx和/或TBx后接受了RP。RBx + TBx联合检查时ISUP一致性率为49%（51/104），而TBx单独检查时为43.3%（P = 0.07），RBx单独检查时为43.3%（P = 0.13）。采用RBx时，50%的患者分级降低（52/104），而采用TBx时为42.3%（44/104）（P = 0.088）。与RP的ISUP评分相比，RBx + TBx联合检查显著降低了ISUP评分的降低率，分别为35.6%（37/104），而RBx单独检查时为50%（P = 0.0001），TBx单独检查时为42.3%（P = 0.016）。
结论
与RP标本相比，在一半的病例中，RBx低估了ISUP评分。在RBx基础上增加TBx可显著减少分级降低。两种活检技术的联合似乎是最接近RP标本的ISUP评分和GS的最佳方案。
证据级别
C级
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