Department of Urology, Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China.
Department of Urology, Third Affiliated Hospital, Yuedong Hospital, Sun Yat-Sen University, New County Park North Road, Meizhou, Guangdong Province, China.
BMC Urol. 2023 May 3;23(1):81. doi: 10.1186/s12894-023-01245-2.
To explore the role of Trans-rectal Color Doppler Flow Imaging (TR-CDFI) and risk-stratification nomogram in a MRI-directed biopsy pathway and examine its clinical performance, via comparisons between existing four biopsy pathways.
A Bi-centered retrospective cohort study on biopsy-naïve male population who received ultrasound-guided prostate biopsy from Jan. 2015 to Feb. 2022 was proposed. All enrolled patients should have undergone serum-PSA test, TR-CDFI and multiparametric MRI before biopsy, and subsequently opted for surgical intervention, enabling more accurate pathological grading. We then utilized univariate and multivariate logistic regression analysis to construct a predictive nomogram for risk-stratification. Outcome measurements were overall prostate cancer (PCA) detection rate, clinically significant PCA (csPCA) detection rate, clinically insignificant PCA (cisPCA) detection rate, biopsy avoidance rate and missed csPCA detection rate. Decision curve analysis was used to compare the performances between diagnostic pathways.
Under the criteria mentioned above, 752 patients from two centers were included. Reference pathway (biopsy for all) showed that overall PCA detection rate was 46.1%, csPCA and cisPCA detection rates were 32.3% and 13.8% respectively. Risk-based MRI-directed TR-CDFI pathway, which incorporated both TR-CDFI and risk stratification nomogram, exhibited PCA detection rate of 38.7%, csPCA detection rate of 28.7%, cisPCA detection rate of 7.0%, Biopsy avoidance rate of 42.4%, and missed csPCA detection rate of 3.6%. Decision curve analysis revealed that the risk-based pathway held the most net benefit, under the threshold probability level between 0.1 and 0.5.
The risk-based MRI-directed TR-CDFI pathway out-performed other strategies, balancing csPCA detection and biopsy avoidance. This suggested that incorporation of TR-CDFI and risk-stratification nomogram in the early PCA diagnostic procedures could reduce unnecessary biopsies.
为了探索经直肠彩色多普勒血流成像（TR-CDFI）和风险分层列线图在 MRI 引导下活检途径中的作用，并通过与现有的四种活检途径进行比较来检验其临床性能。
本研究采用双中心回顾性队列研究，纳入 2015 年 1 月至 2022 年 2 月期间接受超声引导前列腺活检的活检初治男性人群。所有入组患者均接受血清前列腺特异抗原（PSA）检测、TR-CDFI 和多参数 MRI 检查，然后选择手术干预，以获得更准确的病理分级。随后，我们采用单变量和多变量逻辑回归分析构建风险分层预测列线图。主要观察指标为总前列腺癌（PCA）检出率、临床显著 PCA（csPCA）检出率、临床非显著 PCA（cisPCA）检出率、活检回避率和漏诊 csPCA 检出率。决策曲线分析用于比较不同诊断途径的性能。
根据上述标准，共有来自两个中心的 752 例患者被纳入研究。参考途径（所有患者均行活检）显示总 PCA 检出率为 46.1%，csPCA 和 cisPCA 检出率分别为 32.3%和 13.8%。基于风险的 MRI 引导的 TR-CDFI 途径，同时结合了 TR-CDFI 和风险分层列线图，其 PCA 检出率为 38.7%，csPCA 检出率为 28.7%，cisPCA 检出率为 7.0%，活检回避率为 42.4%，漏诊 csPCA 检出率为 3.6%。决策曲线分析显示，在阈值概率水平为 0.1 至 0.5 之间，基于风险的途径具有最大的净获益。
基于风险的 MRI 引导的 TR-CDFI 途径优于其他策略，在平衡 csPCA 检出率和活检回避率方面表现更佳。这表明，在早期 PCA 诊断过程中结合 TR-CDFI 和风险分层列线图可以减少不必要的活检。
