GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Urology, Sorbonne Université, Paris, France.
CNRS UMR 7222, INSERM U1150, Institut des Systèmes Intelligents et Robotique (ISIR), Sorbonne Université, Paris, France.
BJU Int. 2024 Jun;133(6):709-716. doi: 10.1111/bju.16287. Epub 2024 Jan 31.
To report the learning curve of multiple operators for fusion magnetic resonance imaging (MRI) targeted biopsy and to determine the number of cases needed to achieve proficiency.
All adult males who underwent fusion MRI targeted biopsy between February 2012 and July 2021 for clinically suspected prostate cancer (PCa) in a single centre were included. Fusion transrectal MRI targeted biopsy was performed under local anaesthesia using the Koelis platform. Learning curves for segmentation of transrectal ultrasonography (TRUS) images and the overall MRI targeted biopsy procedure were estimated with locally weighted scatterplot smoothing by computing each operator's timestamps for consecutive procedures. Non-risk-adjusted cumulative sum (CUSUM) methods were used to create learning curves for clinically significant (i.e., International Society of Urological Pathology grade ≥ 2) PCa detection.
Overall, 1721 patients underwent MRI targeted biopsy in our centre during the study period. The median (interquartile range) times for TRUS segmentation and for the MRI targeted biopsy procedure were 4.5 (3.5, 6.0) min and 13.2 (10.6, 16.9) min, respectively. Among the 14 operators with experience of more than 50 cases, a plateau was reached after 40 cases for TRUS segmentation time and 50 cases for overall MRI targeted biopsy procedure time. CUSUM analysis showed that the learning curve for clinically significant PCa detection required 25 to 45 procedures to achieve clinical proficiency. Pain scores ranged between 0 and 1 for 84% of patients, and a plateau phase was reached after 20 to 100 cases.
A minimum of 50 cases of MRI targeted biopsy are necessary to achieve clinical and technical proficiency and to reach reproducibility in terms of timing, clinically significant PCa detection, and pain.
报告多位操作者进行融合磁共振成像（MRI）靶向活检的学习曲线，并确定达到熟练程度所需的病例数。
本研究纳入了 2012 年 2 月至 2021 年 7 月期间在一家中心因临床疑似前列腺癌（PCa）接受融合经直肠 MRI 靶向活检的所有成年男性患者。在局部麻醉下，使用 Koelis 平台进行融合经直肠超声（TRUS）图像的分割和整体 MRI 靶向活检。通过计算每个操作者连续手术的时间戳，使用局部加权散点平滑法估计 TRUS 图像分割和整体 MRI 靶向活检过程的学习曲线。使用非风险调整累积和（CUSUM）方法为临床上显著（即国际泌尿病理学会分级≥2）的 PCa 检测创建学习曲线。
在研究期间，共有 1721 例患者在我们中心接受了 MRI 靶向活检。TRUS 分割和 MRI 靶向活检程序的中位数（四分位间距）时间分别为 4.5（3.5，6.0）min 和 13.2（10.6，16.9）min。在经验超过 50 例的 14 位操作者中，TRUS 分割时间达到 40 例，整体 MRI 靶向活检程序时间达到 50 例时达到平台期。CUSUM 分析表明，临床上显著的 PCa 检测的学习曲线需要 25 至 45 例才能达到临床熟练程度。84%的患者疼痛评分在 0 到 1 之间，20 到 100 例之间达到平台期。
至少需要 50 例 MRI 靶向活检才能达到临床和技术熟练程度，并在时间、临床上显著的 PCa 检测和疼痛方面达到可重复性。
