Xu Linhan, Ye Nancy Yating, Lee Adrianna, Chopra Jasleen, Naslund Michael, Wong-You-Cheong Jade, Wnorowski Amelia, Siddiqui Mohummad Minhaj
University of Maryland School of Medicine, Baltimore, MD, USA.
Division of Urology, Department of General Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
Curr Urol. 2023 Sep;17(3):159-164. doi: 10.1097/CU9.0000000000000116. Epub 2022 Aug 22.
Targeted magnetic resonance (MR) with ultrasound (US) fusion-guided biopsy has been shown to improve detection of prostate cancer. The implementation of this approach requires integration of skills from radiologists and urologists. Objective methods for assessment of learning curves, such as cumulative sum (CUSUM) analysis, may be helpful in identifying the presence and duration of a learning curve. The aim of this study is to determine the learning curve for MR/US fusion-guided biopsy in detecting clinically significant prostate cancer using CUSUM analysis.
Retrospective analysis was performed in this institutional review board-approved study. Two urologists implemented an MR/US fusion-guided prostate biopsy program between March 2015 and September 2017. The primary outcome measure was cancer detection rate (CDR) stratified by Prostate Imaging Reporting and Data System (PI-RADS) scores assigned on the MR imaging. Cumulative sum analysis quantified actual cancer detection versus a predetermined target satisfactory CDR of MR/US fusion biopsies in a sequential case-by-case basis. For this analysis, satisfactory performance was defined as >80% CDR in patients with PI-RADS 5, >50% in PI-RADS 4, and <20% in PI-RADS 1-3.
Complete data were available for MR/US fusion-guided biopsies performed on 107 patients. The CUSUM learning curve analysis demonstrated intermittent underperformance until approximately 50 cases. After this inflection point, there was consistently good performance, evidence that no further learning curve was being encountered.
At a new center implementing MR/US fusion-guided prostate biopsy, the learning curve was approximately 50 cases before a consistently high performance for prostate cancer detection.
超声（US）融合引导下的靶向磁共振（MR）活检已被证明可提高前列腺癌的检测率。这种方法的实施需要整合放射科医生和泌尿科医生的技能。评估学习曲线的客观方法，如累积和（CUSUM）分析，可能有助于确定学习曲线的存在和持续时间。本研究的目的是使用CUSUM分析确定MR/US融合引导活检在检测临床显著性前列腺癌中的学习曲线。
在本机构审查委员会批准的研究中进行了回顾性分析。两名泌尿科医生在2015年3月至2017年9月期间实施了MR/US融合引导的前列腺活检计划。主要结局指标是根据MR成像上分配的前列腺影像报告和数据系统（PI-RADS）评分分层的癌症检测率（CDR）。累积和分析在逐个病例的基础上量化了实际癌症检测与MR/US融合活检预定目标满意CDR的情况。对于该分析，满意表现定义为PI-RADS 5患者的CDR>80%，PI-RADS 4患者的CDR>50%，PI-RADS 1-3患者的CDR<20%。
有107例患者接受MR/US融合引导活检的完整数据。CUSUM学习曲线分析表明，在大约50例病例之前存在间歇性表现不佳的情况。在这个转折点之后，表现一直良好，这表明不再存在进一步的学习曲线。
在一个新开展MR/US融合引导前列腺活检的中心，在前列腺癌检测持续保持高性能之前，学习曲线大约为50例。
