一种新的前列腺癌活检方案：靶向和区域性系统活检。
A novel biopsy scheme for prostate cancer: targeted and regional systematic biopsy.
机构信息
Department of Urology, The Institute of Urology, Peking University First Hospital, Peking University, The National Urological Cancer Center of China, No. 8 Xishiku St., Xicheng District, Beijing, 100034, China.
Institution of Urology, PekingUniversity, Beijing, 100034, China.
出版信息
BMC Urol. 2024 Apr 13;24(1):85. doi: 10.1186/s12894-024-01461-4.
PURPOSE
To explore a novel biopsy scheme for prostate cancer (PCa), and test the detection rate and pathological agreement of standard systematic (SB) + targeted (TB) biopsy and novel biopsy scheme.
METHODS
Positive needles were collected from 194 patients who underwent SB + TB (STB) followed by radical prostatectomy (RP). Our novel biopsy scheme, targeted and regional systematic biopsy (TrSB) was defined as TB + regional SB (4 SB-needles closest to the TB-needles). The McNemar test was utilized to compare the detection rate performance for clinical significant PCa (csPCa) and clinical insignificant PCa (ciPCa). Moreover, the accuracy, positive predictive value (PPV) and negative predictive value (NPV) were investigated. The agreement between the different biopsy schemes grade group (GG) and RP GG were assessed. The concordance between the biopsy and the RP GG was evaluated using weighted κ coefficient analyses.
RESULTS
In this study, the overall detection rate for csPCa was 83.5% (162 of 194) when SB and TB were combined. TrSB showed better NPV than TB (97.0% vs. 74.4%). Comparing to STB, the TB-detection rate of csPCa had a significant difference (p < 0.01), while TrSB showed no significant difference (p > 0.999). For ciPCa, the overall detection rate was 16.5% (32 of 194). TrSB showed better PPV (96.6% vs. 83.3%) and NPV (97.6% vs. 92.9%) than TB. Comparing to STB, the detection rate of both schemes showed no significant difference (p = 0.077 and p = 0.375). All three schemes GG showed poor agreement with RP GG (TB: 43.3%, TrSB: 46.4%, STB: 45.9%). Using weighted κ, all three schemes showed no difference (TB: 0.48, TrSB: 0.51, STB: 0.51). In our subgroup analysis (PI-RADS = 4/5, n = 154), all three schemes almost showed no difference (Weighted κ: TB-0.50, TrSB-0.51, STB-0.50).
CONCLUSION
Our novel biopsy scheme TrSB (TB + 4 closest SB needles) may reduce 8 cores of biopsy compared with STB (standard SB + TB), which also showed better csPCa detection rate than TB only, but the same as STB. The pathological agreement between three different biopsy schemes (TB/TrSB/STB) GG and RP GG showed no difference.
目的
探索一种新的前列腺癌（PCa）活检方案，并检测标准系统（SB）+靶向（TB）活检和新活检方案的检测率和病理一致性。
方法
对 194 例接受 SB+TB（STB）后行根治性前列腺切除术（RP）的患者进行研究，收集阳性活检针。我们的新活检方案靶向和区域性系统活检（TrSB）定义为 TB+区域性 SB（距 TB 活检针最近的 4 个 SB 活检针）。采用 McNemar 检验比较临床显著前列腺癌（csPCa）和临床不显著前列腺癌（ciPCa）的检测率。此外，还研究了准确性、阳性预测值（PPV）和阴性预测值（NPV）。评估了不同活检方案分级组（GG）与 RP GG 的一致性。采用加权 κ 系数分析评估活检与 RP GG 的一致性。
结果
在这项研究中，当 SB 和 TB 联合使用时，csPCa 的总检测率为 83.5%（162/194）。TrSB 显示出比 TB 更好的 NPV（97.0% vs. 74.4%）。与 STB 相比，TB 检测 csPCa 的检出率有显著差异（p<0.01），而 TrSB 无显著差异（p>0.999）。对于 ciPCa，总检出率为 16.5%（32/194）。TrSB 显示出比 TB 更好的 PPV（96.6% vs. 83.3%）和 NPV（97.6% vs. 92.9%）。与 STB 相比，两种方案的检出率均无显著差异（p=0.077 和 p=0.375）。三种方案的 GG 与 RP GG 均显示出较差的一致性（TB：43.3%，TrSB：46.4%，STB：45.9%）。采用加权 κ，三种方案均无差异（TB：0.48，TrSB：0.51，STB：0.51）。在我们的亚组分析（PI-RADS=4/5，n=154）中，三种方案几乎没有差异（加权 κ：TB-0.50，TrSB-0.51，STB-0.50）。
结论
我们的新活检方案 TrSB（TB+4 个最近的 SB 活检针）与 STB（标准 SB+TB）相比，可减少 8 个活检针，且与仅 TB 相比，csPCa 的检出率也更高，但与 STB 相同。三种不同活检方案（TB/TrSB/STB）GG 与 RP GG 的病理一致性无差异。
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