Department of Urology, Barmherzige Schwestern Krankenhaus, Vienna, Austria.
Medical Department II, Barmherzige Schwestern Krankenhaus, Vienna, Austria.
World J Urol. 2023 Apr;41(4):1055-1060. doi: 10.1007/s00345-023-04339-6. Epub 2023 Feb 25.
To compare multiparametric magnetic resonance imaging (mpMRI) findings, US-MR fusion prostate biopsy results and whole-mount thin-section histopathology after radical prostatectomy.
Overall 259 patients, who had undergone mpMRI with lesions reported as PI-RADS 3-5, underwent a MR-US fusion biopsy between 2018 and 2020. Overall 186 biopsies yielded prostate cancer and 104 patients subsequently underwent endoscopic extraperitoneal radical prostatectomy. Histopathology of biopsies was compared to the final histopathology in whole mount thin sections after radical prostatectomy by means of descriptive statistics, and further, the lesions from mpMRT were compared to whole mount histology.
Prostate cancer was diagnosed in 186 (71.8%) of 259 patients (median age 69.2 y, range 42-82 y, median PSA 7.8 ng/ml, range 2.1-31.3 ng/ml). Of those, 95 (51,1%) underwent radical endoscopic prostatectomy, and 80 (43%) chose radiotherapy or active surveillance. In 52/95 (54,7%) with RPE additional lesions were found in the final histological whole mount sections not described at mpMRI. 22/95 (23,2%) of RPE patients had ≥ 1 additional Gleason score ≥ 7 lesions, 23 /259 (8,4%) of biopsies, respectively. The Gleason score after surgery was upgraded in 37/95 (38,9%) and downgraded in 18/95 (18,9%) patients.
If we compare all 259 performed biopsies with the final histological whole mount sections which showed additional lesions with Gleason ≥ 7 (23,2%), it can be assumed that up to 10% of clinical significant carcinomas are missed during primary assessment via mpMRI. The majority of additional findings after RP were intermediate/high risk tumors. Upgrades from low-risk to intermediate or high-risk occurred.
比较多参数磁共振成像（mpMRI）结果、磁共振超声融合前列腺活检结果和根治性前列腺切除术后全切片薄组织病理学。
共有 259 例患者接受了 MRI 检查，病变报告为 PI-RADS 3-5，2018 年至 2020 年间进行了磁共振超声融合活检。186 例活检发现前列腺癌，104 例患者随后行经腹腹腔镜根治性前列腺切除术。通过描述性统计比较活检的组织病理学与根治性前列腺切除术后全切片薄组织学的最终组织病理学，并进一步比较 mpMRI 的病变与全切片组织学。
259 例患者中有 186 例（71.8%）诊断为前列腺癌（中位年龄 69.2 岁，范围 42-82 岁，中位 PSA 7.8ng/ml，范围 2.1-31.3ng/ml）。其中 95 例（51.1%）行根治性内镜前列腺切除术，80 例（43%）选择放疗或主动监测。在 52/95 例（54.7%）接受 RP 的患者中，在最终的全切片组织学中发现了 mpMRI 未描述的额外病变。95 例（23.2%）接受 RP 的患者中 Gleason 评分≥7 的额外病变≥1 处，而在 259 例活检中，分别有 23 例（8.4%）患者有 Gleason 评分≥7 的额外病变。术后 Gleason 评分升级 37 例（38.9%），降级 18 例（18.9%）。
如果我们将所有 259 例活检与最终的全切片组织学进行比较，发现 Gleason≥7 的额外病变（23.2%），那么在原发性评估期间，通过 mpMRI 可能会漏诊高达 10%的有临床意义的癌。RP 后大多数额外发现为中高危肿瘤。发生了从低危到中危或高危的升级。
