Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium.
Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
World J Urol. 2023 Jun;41(6):1519-1525. doi: 10.1007/s00345-023-04386-z. Epub 2023 Apr 3.
There is currently no consensus regarding the optimal number of multiparametric magnetic resonance imaging (MRI)-targeted biopsy (TB) cores and their spatial distribution within the MRI lesion. We aim to determine the number of TB cores and location needed to adequately detect csPCa.
We conducted a retrospective cohort study of 505 consecutive patients undergoing TB for positive MRI lesions defined by a PI-RADS score ≥ 3 between June 2016 and January 2022. Cores chronology and locations were prospectively recorded. The co-primary outcomes were the first core to detect clinically significant prostate cancer (csPCa) and the first highest ISUP grade group. The incremental benefit of each additional core was evaluated. Analysis was then performed by distinguishing central (cTB) and peripheral (pTB) within the MRI lesion.
Overall, csPCa was detected in 37% of patients. To reach a csPCa detection rate of 95%, a 3-core strategy was required, except for patients with PI-RADS 5 lesions and those with PSA density ≥ 0.2 ng/ml/cc who benefited from a fourth TB core. At multivariable analysis, only a PSA density ≥ 0.2 ng/ml/cc was an independent predictive factor of having the highest ISUP grade group on the fourth TB cores (p = 0.03). No significant difference in the cancer detection rate was found between cTB and pTB (p = 0.9). Omitting pTB would miss 18% of all csPCa.
A 3-core strategy should be considered for TB to optimize csPCa detection with additional cores needed for PI-RADS 5 lesions and high PSA density. Biopsy cores from both central and peripheral zones are required.
目前对于在 MRI 病变内进行 MRI 靶向活检（TB）的最佳活检针数及其空间分布尚没有共识。我们旨在确定 TB 针数和位置，以充分检测 csPCa。
我们对 2016 年 6 月至 2022 年 1 月期间因 PI-RADS 评分≥3 而接受 TB 的 505 例连续患者进行了回顾性队列研究。前瞻性记录了针芯的时间顺序和位置。主要的共同结果是首次检测到临床显著前列腺癌（csPCa）的针芯和首次最高 ISUP 分级组。评估了每个额外针芯的增量获益。然后通过区分 MRI 病变内的中央（cTB）和外周（pTB）来进行分析。
总体而言，37%的患者检测到 csPCa。为了达到 95%的 csPCa 检测率，需要 3 针策略，除了 PI-RADS 5 病变和 PSA 密度≥0.2ng/ml/cc 的患者，他们需要第 4 针 TB。多变量分析显示，只有 PSA 密度≥0.2ng/ml/cc 是第 4 针 TB 获得最高 ISUP 分级组的独立预测因素（p=0.03）。cTB 和 pTB 之间的癌症检出率无显著差异（p=0.9）。忽略 pTB 会错过 18%的所有 csPCa。
对于 TB，应考虑采用 3 针策略，以优化 csPCa 的检测，对于 PI-RADS 5 病变和高 PSA 密度，需要增加针数。需要从中央和外周区采集活检针芯。
