3.0-T MR 引导下经直肠超声盲区靶向经直肠前列腺穿刺活检术在无直肠入路患者中的应用：单中心经验及文献复习。

3.0-T MR-guided transgluteal in-bore-targeted prostate biopsy under local anesthesia in patients without rectal access: a single-institute experience and review of literature.

机构信息

Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA.

Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, 33612, USA.

出版信息

Abdom Radiol (NY). 2024 Apr;49(4):1223-1230. doi: 10.1007/s00261-024-04183-1. Epub 2024 Feb 21.

DOI:10.1007/s00261-024-04183-1

PMID:38383816

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10954944/

Abstract

PURPOSE

To describe the technique and evaluate the performance of MRI-guided transgluteal in-bore-targeted biopsy of the prostate gland under local anesthesia in patients without rectal access.

METHODS

Ten men (mean age, 69 (range 57-86) years) without rectal access underwent 13 MRI-guided transgluteal in-bore-targeted biopsy of the prostate gland under local anesthesia. All patients underwent mp-MRI at our institute prior to biopsy. Three patients had prior US-guided transperineal biopsy which was unsuccessful in one, negative in one, and yielded GG1 (GS6) PCa in one. Procedure time, complications, histopathology result, and subsequent management were recorded.

RESULTS

Median interval between rectal surgery and presentation with elevated PSA was 12.5 years (interquartile range (IQR) 25-75, 8-36.5 years). Mean PSA was 11.9 (range, 4.8 -59.0) ng/ml and PSA density was 0.49 (0.05 -3.2) ng/ml/ml. Distribution of PI-RADS v2.0/2.1 scores of the targeted lesions were PI-RADS 5-3; PI-RADS 4-6; and PI-RADS 3-1. Mean lesion size was 1.5 cm (range, 1.0-3.6 cm). Median interval between MRI and biopsy was 5.5 months (IQR 25-75, 1.5-9 months). Mean procedure time was 47.4 min (range, 29-80 min) and the number of cores varied between 3 and 5. Of the 13 biopsies, 4 yielded clinically significant prostate cancer (csPca), with a Gleason score ≥ 7, 1 yielded insignificant prostate cancer (Gleason score = 6), 7 yielded benign prostatic tissue, and one was technically unsuccessful. 3/13 biopsies were repeat biopsies which detected csPCa in 2 out of the 3 patients. None of the patients had biopsy-related complication. Biopsy result changed management to radiation therapy with ADT in 2 patients with the rest on active surveillance.

CONCLUSION

MRI-guided transgluteal in-bore-targeted biopsy of the prostate gland under local anesthesia is feasible in patients without rectal access.

摘要

目的

描述在局部麻醉下经直肠入路的 MRI 引导经直肠腔内靶向前列腺活检技术，并评估其在无直肠入路患者中的应用效果。

方法

10 名男性（平均年龄 69 岁[范围 57-86 岁]）在局部麻醉下接受了 13 次 MRI 引导经直肠腔内靶向前列腺活检。所有患者在活检前均在我院进行了 mp-MRI 检查。其中 3 名患者曾行超声引导经会阴前列腺活检，但 1 次活检未成功，1 次活检阴性，1 次活检发现 GG1（GS6）前列腺癌。记录手术时间、并发症、组织病理学结果和后续管理情况。

结果

中位直肠手术后至 PSA 升高的时间为 12.5 年（四分位距[IQR]25-75，8-36.5 年）。平均 PSA 为 11.9ng/ml（范围 4.8-59.0ng/ml），PSA 密度为 0.49ng/ml/ml（0.05-3.2ng/ml/ml）。靶向病变的 PI-RADS v2.0/2.1 评分分布为 PI-RADS 5-3；PI-RADS 4-6；和 PI-RADS 3-1。平均病变大小为 1.5cm（范围 1.0-3.6cm）。MRI 与活检之间的中位间隔时间为 5.5 个月（IQR 25-75，1.5-9 个月）。平均手术时间为 47.4 分钟（范围 29-80 分钟），活检针数为 3-5 针。13 次活检中有 4 次活检结果为临床显著前列腺癌（csPca），Gleason 评分≥7，1 次活检结果为不显著前列腺癌（Gleason 评分=6），7 次活检结果为良性前列腺组织，1 次活检结果为技术失败。13 次活检中有 3 次为重复活检，其中 3 例中的 2 例检测到 csPca。所有患者均无活检相关并发症。活检结果改变了 2 例患者的管理方案，使其接受放射治疗联合雄激素剥夺治疗，其余患者接受主动监测。