Department of Urology, Sestre milosrdnice University Hospital Center.
Ljudevit Jurak Clinical Department of Pathology and Cytology, Sestre milosrdnice University Hospital Center.
Acta Clin Croat. 2022 Oct;61(Suppl 3):28-31. doi: 10.20471/acc.2022.61.s3.4.
All malignancies, including prostate cancer, require accurate diagnosing and staging before making a treatment decision. The introduction of targeted biopsies based on prostate MRI findings has raised prostate biopsy accuracy. Guided biopsies target the tumor itself during the biopsy instead of the most common tumor sites as is the case with a systemic biopsy. Some studies report that targeted biopsies should lower prostate cancer biopsy undergrading and overgrading.
To determine the incidence of prostate cancer biopsy undergrading in patients who underwent a classic systemic biopsy compared to patients who underwent a mpMRI cognitive targeted biopsy.
We identified the patients from our database who underwent a radical prostatectomy at our institution from January 1st, 2021, to June 30th, 2021.There were 112 patients identified. Patients were stratified into two groups based on the type of biopsy that confirmed prostate cancer. The mpMRI (N=50) group had a mpMRI cognitive guided transrectal ultrasound (TRUS) prostate biopsy performed, and the non-mpMRI group (N=62) received a classic, systemic TRUS biopsy. We compared the biopsy results with the final pathological results, and searched for undergrading or overgrading in the biopsies compared to the final histological report.
The undergrading was found in 17,7% (N=11) cases in the non-mpMRI group and in 12,0% (N=6) of cases in the mpMRI group (p=0,02, Mann-Whitney U test). No overgrading was found in our cohort. All cases of undergrading had Grade Group 1 in the biopsy report and Grade Group 2 in the final specimen report. The charasteristics of patients are listed in Table 1.
In our cohort, the patients who underwent a mpMRI targeted biopsy had a lower undergrading incidence. During a systemic TRUS biopsy, the urologist targets the areas of the prostate where cancer is most commonly located, which is usually the peripheral zone of the prostate. Since different areas of the tumor have different areas of differentiation, only a low-grade part of the tumor is sometimes biopsied, which results in a sampling error. Once the prostate is removed, the whole tumor is analyzed, so the obtained pathological results related to the removed prostate are far more accurate than the analysis of prostate cores obtained by biopsy.
所有恶性肿瘤，包括前列腺癌，在做出治疗决策之前都需要准确诊断和分期。基于前列腺 MRI 结果的靶向活检提高了前列腺活检的准确性。靶向活检在活检过程中针对肿瘤本身，而不是像系统活检那样针对最常见的肿瘤部位。一些研究报告称，靶向活检应降低前列腺癌活检的低估和高估分级。
确定接受经典系统活检的患者与接受 mpMRI 认知靶向活检的患者之间前列腺癌活检低估分级的发生率。
我们从我们的数据库中确定了 2021 年 1 月 1 日至 2021 年 6 月 30 日期间在我们机构接受根治性前列腺切除术的患者。共确定了 112 名患者。根据确认前列腺癌的活检类型，将患者分为两组。mpMRI（N=50）组接受 mpMRI 认知引导经直肠超声（TRUS）前列腺活检，非 mpMRI 组（N=62）接受经典系统 TRUS 活检。我们将活检结果与最终病理结果进行比较，并在活检与最终组织学报告中寻找低估或高估分级。
非 mpMRI 组中有 17.7%（N=11）的病例存在低估分级，mpMRI 组中有 12.0%（N=6）的病例存在低估分级（p=0.02，Mann-Whitney U 检验）。我们的队列中没有发现高估分级。所有低估分级的病例在活检报告中均为 1 级，在最终标本报告中均为 2 级。患者的特征列于表 1。
在我们的队列中，接受 mpMRI 靶向活检的患者低估分级发生率较低。在系统 TRUS 活检中，泌尿科医生靶向前列腺癌最常见的部位，通常是前列腺的外周区。由于肿瘤的不同部位有不同的分化程度，有时只对肿瘤的低级别部分进行活检，导致取样误差。一旦前列腺被切除，整个肿瘤都被分析，因此获得的与切除前列腺相关的病理结果比通过活检获得的前列腺核心分析结果要准确得多。
