Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, 683-8504, Japan.
BMC Urol. 2024 Apr 4;24(1):79. doi: 10.1186/s12894-024-01473-0.
Multiparametric MRI (mpMRI) is widely used for the diagnosis, surveillance, and staging of prostate cancer. However, it has several limitations, including higher costs, longer examination times, and the use of gadolinium-based contrast agents. This study aimed to investigate the accuracy of preoperatively assessed index tumors (ITs) using biparametric MRI (bpMRI)/transrectal ultrasound (TRUS) fusion biopsy compared with radical prostatectomy (RP) specimens.
We included 113 patients diagnosed with prostate cancer through bpMRI/TRUS fusion-guided biopsies of lesions with a Prostate Imaging Reporting and Data System (PI-RADS) category ≥ 3. These patients underwent robot-assisted laparoscopic radical prostatectomy (RARP) at our institution between July 2017 and March 2023. We examined the localization of preoperative and postoperative ITs, the highest Gleason score (GS), and tumor diameter in these patients.
The preoperative cT stage matched the postoperative pT stage in 53 cases (47%), while 31 cases (27%) were upstaged, and 29 cases (26%) were downstaged (Weighted Kappa = 0.21). The preoperative and postoperative IT localizations were consistent in 97 cases (86%). The concordance rate between Gleason groups in targeted biopsies and RP specimens was 51%, with an upgrade in 25 cases (23%) and a downgrade in 27 cases (25%) (Weighted Kappa = 0.42). The maximum diameter of the IT and the maximum cancer core length on biopsy were correlated with the RP tumor's maximum diameter (p < 0.001 for both).
The diagnostic accuracy of bpMRI/TRUS fusion biopsy is comparable to mpMRI, suggesting that it can be a cost-effective and time-saving alternative.
多参数磁共振成像（mpMRI）广泛用于前列腺癌的诊断、监测和分期。然而，它存在一些局限性，包括更高的成本、更长的检查时间以及使用钆基造影剂。本研究旨在探讨使用双参数磁共振成像（bpMRI）/经直肠超声（TRUS）融合活检术前评估的指数肿瘤（IT）与根治性前列腺切除术（RP）标本的准确性。
我们纳入了 113 名通过 bpMRI/TRUS 融合引导活检诊断为前列腺癌的患者，这些患者的病变前列腺影像报告和数据系统（PI-RADS）评分≥3。这些患者在我们机构接受了机器人辅助腹腔镜根治性前列腺切除术（RARP），时间在 2017 年 7 月至 2023 年 3 月之间。我们检查了这些患者的术前和术后 IT 定位、最高 Gleason 评分（GS）和肿瘤直径。
53 例（47%）患者术前 cT 期与术后 pT 期相匹配，31 例（27%）患者分期升高，29 例（26%）患者分期降低（加权 Kappa=0.21）。97 例（86%）患者的术前和术后 IT 定位一致。靶向活检和 RP 标本的 Gleason 分组之间的一致性率为 51%，其中 25 例（23%）升级，27 例（25%）降级（加权 Kappa=0.42）。IT 的最大直径和活检中最大癌核长度与 RP 肿瘤的最大直径相关（两者均 p<0.001）。
bpMRI/TRUS 融合活检的诊断准确性与 mpMRI 相当，提示其是一种具有成本效益和节省时间的替代方法。
