Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy.
Radiology Unit, University Hospital of Padua, Padua, Italy.
Prostate Cancer Prostatic Dis. 2024 Mar;27(1):129-135. doi: 10.1038/s41391-023-00733-8. Epub 2023 Oct 12.
Based on the findings of different trials in biopsy naïve patients, target biopsy (TB) plus random biopsy (RB) during mpMRI-guided transrectal ultrasound fusion biopsy (FB) are often also adopted for the biopsy performed during active surveillance (AS) programs. At the moment, a clear consensus on the extent and modalities of the procedure is lacking.
To evaluate the increase in diagnostic accuracy achieved by perilesional biopsy (PL) and different RB schemes during FB performed in AS protocol.
DESIGN, SETTING, AND PARTICIPANTS: We collected prospectively the data of 112 consecutive patients with low- or very-low-risk prostate cancer; positive mpMRI underwent biopsy at a single academic institution in the context of an AS protocol.
INTERVENTION(S): mpMRI/transrectal US FB with Hitachi RVS system with 3 TB and concurrent transrectal 24-core RB.
The diagnostic yield of the different possible biopsy schemes (TB only; TB + 4 perilesional (PL) cores; TB + 12-core RB; TB + 24-core RB) was compared by the McNemar test. Univariable and multivariable regression analyses were adopted to identify predictors of any cancer, Gleason grade group (GGG) ≥2 cancers, and the presence of GGG≥2 cancers in the larger schemes only.
The detection rate of GGG ≥2 cancers increased to 30%, 39%, and 49% by adding 4 PL cores, 14, and 24 RB cores, respectively, to TB cores (all p values <0.01). On the whole, TB alone, 14-core RB, and 24-core-RB identified 38%, 47%, and 56% of all the GGG ≥2 cancers. Such figures increased to 62% by adding to TB 4 PL cores, and to 80% by adding 14 RB cores. Most of the differences were observed in PI-RADS 4 lesions.
We found that PL biopsy increased the detection rate of GGG ≥2 cancers as compared with TB alone. However, the combination of those cores missed a large percentage of the CS cancers identified with larger RB cores, including a 20% of CS cancers diagnosed only by the combination of TB plus 24-core RB.
基于不同的活检初治患者试验结果，靶向活检（TB）联合随机活检（RB）在 mpMRI 引导下经直肠超声融合活检（FB）中也经常用于主动监测（AS）项目中的活检。目前，对于该操作的范围和模式尚缺乏明确共识。
评估在 AS 方案中进行 FB 时，采用 PL 活检和不同 RB 方案对提高诊断准确性的作用。
设计、地点和参与者：我们前瞻性收集了 112 例低危或极低危前列腺癌患者的数据；mpMRI 阳性患者在一家学术机构进行 FB，作为 AS 方案的一部分。
mpMRI/经直肠超声 FB，采用日立 RVS 系统，进行 3 次 TB 和同时经直肠 24 核 RB。
采用 McNemar 检验比较不同活检方案（仅 TB；TB+4 个周边（PL）核；TB+12 核 RB；TB+24 核 RB）的诊断率。采用单变量和多变量回归分析，确定仅在较大方案中发现任何癌症、Gleason 分级组（GGG）≥2 癌症和 GGG≥2 癌症的预测因素。
增加 4 个 PL 核、14 个和 24 个 RB 核后，GGG≥2 癌症的检出率分别提高至 30%、39%和 49%（所有 p 值均<0.01）。总体而言，仅 TB、14 核 RB 和 24 核 RB 可分别检出 38%、47%和 56%的所有 GGG≥2 癌症。加入 4 个 PL 核后，这些数字增加至 62%，加入 14 个 RB 核后增加至 80%。大多数差异发生在 PI-RADS 4 病变中。
我们发现，与单独 TB 相比，PL 活检增加了 GGG≥2 癌症的检出率。然而，这些核的组合漏诊了很大一部分 CS 癌症，包括仅通过 TB 加 24 核 RB 组合诊断的 20%的 CS 癌症。
