[针对PI-RADS 5级患者采用靶向活检联合6针系统活检诊断前列腺癌的效能]
[Diagnostic efficacy of prostate cancer using targeted biopsy with 6-core systematic biopsy for patients with PI-RADS 5].
作者信息
Liu Yi, Yuan Chang Wei, Wu Jing Yun, Shen Qi, Xiao Jiang Xi, Zhao Zheng, Wang Xiao Ying, Li Xue Song, He Zhi Song, Zhou Li Qun
机构信息
Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
Department of Radiology, Peking University First Hospital, Beijing 100034, China.
出版信息
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Oct 18;55(5):812-817. doi: 10.19723/j.issn.1671-167X.2023.05.006.
OBJECTIVE
To investigate the diagnostic efficacy of targeted biopsy (TBx), systematic biopsy (SBx), TBx+6-core SBx in prostate cancer (PCa) / clinically significant prostate cancer (cs-PCa) for patients with prostate imaging reporting and data system (PI-RADS) score of 5, and thereby to explore an optimal sampling scheme.
METHODS
The data of 585 patients who underwent multiparametric magnetic resonance imaging (mpMRI) with at least one lesion of PI-RADS score 5 at Peking University First Hospital from January 2019 to June 2022 were retrospectively analyzed. All patients underwent mpMRI / transrectal ultrasound (TRUS) cognitive guided biopsy (TBx+SBx). With the pathological results of combined biopsy as the gold standard, we compared the diagnostic efficacy of TBx only, SBx only, and TBx+6-core SBx for PCa/csPCa. The patients were grouped according to mpMRI T-stage (cT2, cT3, cT4) and the detection rates of different biopsy schemes for PCa/csPCa were compared using Cochran's and McNemar tests.
RESULTS
Among 585 patients with a PI-RADS score of 5, 560 (95.7%) were positive and 25(4.3%) were negative TBx+SBx. After stratified according to mpMRI T-stage, 233 patients (39.8%) were found in cT2 stage, 214 patients (36.6%) in cT3 stage, and 138 patients (23.6%) in cT4 stage. There was no statistically significant difference in the detection rate of PCa/csPCa between TBx+6-core SBx and TBx+SBx (all >0.999). Also, there was no statistically significant difference in the detection rate of PCa/csPCa between TBx and TBx+SBx in the cT2, cT3, and cT4 subgroups (PCa: =0.203, =0.250, >0.999; csPCa: =0.700, =0.250, >0.999). The missed diagnosis rate of SBx for PCa and csPCa was 2.1% (12/560) and 1.8% (10/549), and that of TBx for PCa and csPCa was 1.8% (10/560) and 1.4% (8/549), respectively. However, the detection rate of TBx+6-core SBx for PCa and csPCa was 100%. Compared with TBx+SBx, TBx and TBx+6-core SBx had a fewer number of cores and a higher detection rate per core ( < 0.001).
CONCLUSION
For patients with a PI-RADS score of 5, TBx and TBx+6-core SBx showed the same PCa/csPCa detection rates and a high detection rates per core as that of TBx+SBx, which can be considered as an optimal scheme for prostate biopsy.
目的
探讨靶向活检（TBx）、系统活检（SBx）、TBx + 6针系统活检在前列腺影像报告和数据系统（PI-RADS）评分为5分的前列腺癌（PCa）/临床意义前列腺癌（cs-PCa）中的诊断效能，从而探索最佳取材方案。
方法
回顾性分析2019年1月至2022年6月在北京大学第一医院接受多参数磁共振成像（mpMRI）且至少有一个PI-RADS评分为5分病灶的585例患者的数据。所有患者均接受mpMRI/经直肠超声（TRUS）认知引导活检（TBx + SBx）。以联合活检的病理结果为金标准，比较单纯TBx、单纯SBx、TBx + 6针SBx对PCa/csPCa的诊断效能。根据mpMRI T分期（cT2、cT3、cT4）对患者进行分组，采用 Cochr an检验和McNemar检验比较不同活检方案对PCa/csPCa的检出率。
结果
585例PI-RADS评分为5分的患者中，TBx + SBx结果阳性560例（95.7%），阴性25例（4.3%）。按mpMRI T分期分层后，cT2期233例（39.8%），cT3期214例（36.6%），cT4期138例（23.6%）。TBx + 6针SBx与TBx + SBx对PCa/csPCa的检出率差异无统计学意义（均>0.999）。在cT2、cT3和cT4亚组中，TBx与TBx + SBx对PCa/csPCa的检出率差异也无统计学意义（PCa：=0.203，=0.250，>0.999；csPCa：=0.700，=0.250，>0.999）。SBx对PCa和csPCa的漏诊率分别为2.1%（12/560）和1.8%（10/549），TBx对PCa和csPCa的漏诊率分别为1.8%（10/560）和1.4%（8/549）。然而，TBx + 6针SBx对PCa和csPCa的检出率均为100%。与TBx + SBx相比，TBx和TBx + 6针SBx的取材针数更少，每针的检出率更高（<0.001）。
结论
对于PI-RADS评分为5分的患者，TBx和TBx + 6针SBx对PCa/csPCa的检出率与TBx + SBx相同，且每针检出率高，可作为前列腺活检的最佳方案。
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