Sun Zhoujie, Liu Yi, Yu Wei, Wang He, Shen Qi, Zhang Cuijian
Department of Urology, Peking University First Hospital, No.8 Xishiku St. Xicheng District, Beijing, China.
Institute of Urology, Peking University, No.8 Xishiku St. Xicheng District, Beijing, China.
Insights Imaging. 2024 May 16;15(1):118. doi: 10.1186/s13244-024-01680-1.
To explore the diagnostic performance of targeted biopsy (TB) combined with regional systematic biopsy (RSB) in patients with different Prostate Imaging Reporting and Data System (PI-RADS) and histologic zones for prostate lesions.
This retrospective study included 1301 patients who underwent multiparametric MRI followed by combined MRI/US fusion-guided TB+systematic biopsy (SB) between January 2019 and October 2022. RSB was defined as the four perilesional SB cores adjacent to an MRI-positive lesion. Cancer detection rates were calculated for TB + SB, TB, SB, and TB + RSB, while the McNemar test was utilized for multiple comparisons among them. Subgroup analyses were performed based on different Pl-RADS and histologic zones.
Of 1301 included participants (median age, 68 years; interquartile range, 63-74 years), 16,104 total biopsy cores were performed. TB + RSB detected clinically significant prostate cancer in 70.9% (922/1301) of patients, which was significantly higher than TB (67.4%, p < 0.001) or SB (67.5%, p < 0.001) but similar to TB + SB (71.0%, p = 0.50). Compared with TB + SB, TB + RSB required fewer median biopsy cores (6.3 vs. 12.4, p < 0.001) and had a higher proportion of positive cores (56.3% vs. 39.0%, p < 0.001). Subgroup analysis showed that TB had outstanding sensitivity for detecting PI-RADS 5 lesions in the PZ.
Compared with TB + SB, TB + RSB achieved a similar clinically significant prostate cancer detection rate while requiring fewer biopsy cores and exhibiting higher diagnostic efficiency.
For MRI-positive prostate lesions, targeted biopsy combined with regional systematic biopsy could serve as an alternative diagnostic approach to targeted biopsy combined with systematic biopsy.
The scheme of prostate biopsy needs to be optimized. Regional systematic biopsy decreases the total number of cores taken. Targeted biopsies combined with regional systematic biopsies improve prostate diagnostic efficiency.
探讨靶向活检（TB）联合区域系统活检（RSB）在不同前列腺影像报告和数据系统（PI-RADS）及组织学区域的前列腺病变患者中的诊断性能。
这项回顾性研究纳入了2019年1月至2022年10月期间接受多参数MRI检查，随后进行MRI/超声融合引导下TB + 系统活检（SB）的1301例患者。RSB定义为与MRI阳性病变相邻的四个病变周围SB核心组织。计算TB + SB、TB、SB和TB + RSB的癌症检出率，同时采用McNemar检验对它们进行多重比较。基于不同的PI-RADS和组织学区域进行亚组分析。
在纳入的1301名参与者（中位年龄68岁；四分位间距63 - 74岁）中，共进行了16,104次活检核心组织取材。TB + RSB在70.9%（922/1301）的患者中检测到临床显著前列腺癌，显著高于TB（67.4%，p < 0.001）或SB（67.5%，p < 0.001），但与TB + SB（71.0%，p = 0.50）相似。与TB + SB相比，TB + RSB所需的中位活检核心组织数量更少（6.3对12.4，p < 0.001），阳性核心组织比例更高（56.3%对39.0%，p < 0.001）。亚组分析显示，TB对检测外周带（PZ）中PI-RADS 5级病变具有出色的敏感性。
与TB + SB相比，TB + RSB实现了相似的临床显著前列腺癌检出率，同时所需活检核心组织数量更少，诊断效率更高。
对于MRI阳性的前列腺病变，靶向活检联合区域系统活检可作为靶向活检联合系统活检的替代诊断方法。
前列腺活检方案需要优化。区域系统活检减少了取材的核心组织总数。靶向活检联合区域系统活检提高了前列腺诊断效率。
