Yang Yongjun, He Xianya, Zeng Yiming, Lu Qiang, Li Yuanwei
Department of Urology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China.
Front Oncol. 2024 Mar 11;14:1361093. doi: 10.3389/fonc.2024.1361093. eCollection 2024.
Prostate cancer is the most common malignant tumor of male genitourinary system, and the gold standard for its diagnosis is prostate biopsy. Focusing on the methods and skills of prostate biopsy, we explored the learning curve and experience of a novel magnetic resonance imaging and transrectal ultrasound (mpMRI-TRUS) image fusion transperineal biopsy (TPB) technique using electromagnetic needle tracking under local anesthesia.
The clinical and pathological data of 92 patients who underwent targeted TPB from January 2023 to July 2023 in our center were prospectively collected. The cumulative sum (CUSUM) analysis method and the best fitting curve were used to analyze the learning curve of this novel technique, and the clinical characteristics, perioperative data and tumor positive rate of prostate biopsy of patients at different stages of the learning curve were compared.
With the increase of the number of surgical cases, the overall operative time showed a downward trend. The best fitting curve of CUSUM reached its peak at the twelfth case, which is the minimum cumulative number of surgical cases needed to cross the learning curve of the operation. Taking this as the boundary, the learning curve is divided into two stages: learning improvement stage (group A, 12 cases) and proficiency stage (group B, 80 cases). The surgical time and visual analog scale score during prostate biopsy in group A were significantly higher than those in group B. The visual numerical scale score during prostate biopsy in group A was significantly lower than that in group B. There was no statistically significant difference between group A and group B in the detection rate of csPCa and the incidence of perioperative complications.
The novel targeted TPB technique is divided into learning improvement stage and proficiency stage, and 12 cases may be the least cumulative number.
前列腺癌是男性泌尿生殖系统最常见的恶性肿瘤，其诊断的金标准是前列腺穿刺活检。围绕前列腺穿刺活检的方法和技巧，我们探讨了一种在局部麻醉下使用电磁针跟踪的新型磁共振成像与经直肠超声（mpMRI-TRUS）图像融合经会阴穿刺活检（TPB）技术的学习曲线和经验。
前瞻性收集2023年1月至2023年7月在本中心接受靶向TPB的92例患者的临床和病理数据。采用累积和（CUSUM）分析法和最佳拟合曲线分析该新技术的学习曲线，并比较学习曲线不同阶段患者前列腺穿刺活检的临床特征、围手术期数据和肿瘤阳性率。
随着手术例数的增加，总体手术时间呈下降趋势。CUSUM的最佳拟合曲线在第12例时达到峰值，这是跨越该手术学习曲线所需的最少累积手术例数。以此为界，将学习曲线分为两个阶段：学习改进阶段（A组，12例）和熟练阶段（B组，80例）。A组前列腺穿刺活检时的手术时间和视觉模拟量表评分显著高于B组。A组前列腺穿刺活检时的视觉数字量表评分显著低于B组。A组和B组在临床显著性前列腺癌（csPCa）的检出率和围手术期并发症发生率方面差异无统计学意义。
新型靶向TPB技术分为学习改进阶段和熟练阶段，12例可能是最少累积例数。
