Noh Tae Il, Shim Ji Sung, Kang Seok Ho, Cheon Jun, Kang Sung Gu
Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Front Oncol. 2023 Mar 23;13:1142022. doi: 10.3389/fonc.2023.1142022. eCollection 2023.
To compare the diagnostic performance of transperineal targeted biopsy (TB) or systematic biopsy (SB) alone based on combined TB+SB and radical prostatectomy (RP) specimen for detecting prostate cancer (PCa) according to the prostate imaging reporting and data system (PI-RADS) score.
This study included 1077 men who underwent transperineal bi-parametric (bp) magnetic resonance imaging (MRI)-ultrasound (US) fusion TB+SB (bpMRI-US FTSB) between April 2019 and March 2022. To compare the performance of each modality (TB, SB, and combined TB+SB) with the RP specimen (as the standard) for detecting PCa and clinically significant PCa (csPCa), receiver operating characteristic (ROC) curves were plotted.
PCa was detected in 581 of 1077 men (53.9%) using bpMRI-US FTSB. CsPCa was detected in 383 of 1077 men (35.6%), 17 of 285 (6.0%) with PI-RADS 0 to 2, 35 of 277 (12.6%) with PI-RADS 3, 134 of 274 (48.9%) with PI-RADS 4, and 197 of 241 (81.7%) with PI-RADS 5, respectively. The additional diagnostic value of TB vs. SB compared to combined TB+SB for diagnosing csPCa were 4.3% vs. 3.2% (p=0.844), 20.4% vs 5.1% (p<0.001), and 20.3% vs. 0.7% (p<0.001) with PI-RADS 3, 4, and 5, respectively. TB alone showed no significant difference in diagnostic performance for csPCa with combined TB+SB based on RP specimens in patients with PI-RADS 5 (p=0.732).
A need for addition of SB to TB in patients with PI-RADS 3 and 4 lesions, however, TB alone may be performed without affecting the management of patients with PI-RADS 5.
根据前列腺影像报告和数据系统（PI-RADS）评分，比较经会阴靶向活检（TB）或单纯系统活检（SB）联合TB+SB及根治性前列腺切除术（RP）标本检测前列腺癌（PCa）的诊断性能。
本研究纳入了2019年4月至2022年3月期间接受经会阴双参数（bp）磁共振成像（MRI）-超声（US）融合TB+SB（bpMRI-US FTSB）的1077名男性。为比较各检查方式（TB、SB及联合TB+SB）与RP标本（作为标准）检测PCa和临床显著性PCa（csPCa）的性能，绘制了受试者操作特征（ROC）曲线。
使用bpMRI-US FTSB在1077名男性中的581名（53.9%）检测到PCa。在1077名男性中的383名（35.6%）检测到csPCa，PI-RADS 0至2的285名中有17名（6.0%），PI-RADS 3的277名中有35名（12.6%），PI-RADS 4的274名中有134名（48.9%），PI-RADS 5的241名中有197名（81.7%）。与联合TB+SB相比，TB与SB在诊断csPCa方面的额外诊断价值，PI-RADS 3分别为4.3%对3.2%（p = 0.844），PI-RADS 4为20.4%对5.1%（p < 0.001），PI-RADS 5为20.3%对0.7%（p < 0.001）。对于PI-RADS 5的患者，单纯TB与基于RP标本的联合TB+SB在csPCa诊断性能上无显著差异（p = 0.732）。
PI-RADS 3和4病变的患者需要在TB基础上加做SB，然而，对于PI-RADS 5的患者，可单独进行TB而不影响治疗管理。
