Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy.
Radiology Unit, University Hospital of Padua, Padua, Italy.
World J Urol. 2023 Nov;41(11):3239-3247. doi: 10.1007/s00345-023-04382-3. Epub 2023 Apr 20.
It is still not clear the role of perilesional biopsy (PL) and the extension of the random biopsy (RB) scheme to be adopted during mpMRI-guided ultrasound fusion biopsy (FB). To evaluate the increase in diagnostic accuracy achieved by PL and different RB schemes over target biopsy (TB).
We collected prospectively 168 biopsy-naïve patients with positive mpMRI receiving FB and concurrent 24-core RB. The diagnostic yields of the different possible biopsy schemes (TB only; TB + 4 PL cores; TB + 12-core RB; TB + 24-core RB) were compared by the McNemar test. Clinically significant (CS) prostate cancer (PCA) was defined according to the definition of the PROMIS trial. Regression analyses were used to identify independent predictors of the presence of any cancer, csPCA.
The detection rate of CS cancers increased to 35%, 45%, and 49% by adding 4 PL cores, 12, and 24 RB cores, respectively (all p < 0.02). Notably, the largest scheme including 3 TB and 24 RB cores identified a small but statistically significant 4% increase in detection rate of CS cancer, as compared with the second largest scheme. TB alone identified only 62% of the CS cancers. Such figure increased to 72% by adding 4 PL cores, and to 91% by adding 14 RB cores.
We found that PL biopsy increased the detection rate of CS cancers as compared with TB alone. However, the combination of those cores missed about 30% of the CS cancers identified with larger RB cores, notably including a considerable 15% of cases located contralaterally to the index tumor.
在 mpMRI 引导的超声融合活检（FB）中，尚不清楚瘤周活检（PL）和随机活检（RB）方案的扩展应发挥何种作用。评估 PL 和不同 RB 方案相对于目标活检（TB）在提高诊断准确性方面的作用。
我们前瞻性地收集了 168 例接受 FB 和同时进行 24 芯 RB 的初次活检阳性的 mpMRI 患者。通过 McNemar 检验比较了不同可能活检方案（仅 TB；TB+4 个 PL 核心；TB+12 芯 RB；TB+24 芯 RB）的诊断效果。根据 PROMIS 试验的定义，将临床显著（CS）前列腺癌（PCA）定义为 CS 前列腺癌。回归分析用于识别任何癌症和 CSPCA 的存在的独立预测因素。
通过添加 4 个 PL 核心、12 个和 24 个 RB 核心，CS 癌症的检出率分别提高到 35%、45%和 49%（均 p<0.02）。值得注意的是，包含 3 个 TB 和 24 个 RB 核心的最大方案与第二大方案相比，CS 癌症的检出率仅略有增加 4%。仅 TB 单独识别出仅 62%的 CS 癌症。通过添加 4 个 PL 核心，这一数字增加到 72%，通过添加 14 个 RB 核心，这一数字增加到 91%。
我们发现 PL 活检与单独的 TB 相比增加了 CS 癌症的检出率。然而，这些核心组合漏诊了大约 30%的 CS 癌症，其中包括相当数量的 15%位于肿瘤对侧的病例。
