Yao Kaifeng, Ruan Mingjian, Li Derun, Tian Yuxuan, Chen Yuke, Fan Yu, Liu Yi
Department of Urology, Peking University First Hospital; Institution of Urology, Peking University; Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center; National Urological Cancer Center, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Aug 18;56(4):575-581. doi: 10.19723/j.issn.1671-167X.2024.04.005.
To investigate the diagnostic efficacy of targeted biopsy combined with regional systematic biopsy in prostate cancer (PCa) in patients with prostate imaging reporting and data system v2.1 (PI-RADS v2.1) 4-5.
From January 2023 to October 2023, patients who underwent prostate biopsy for the first time with total prostate specific antigen (tPSA) ≤ 20 ng/mL and had a multi-parametric magnetic resonance imaging (mpMRI) PI-RADS of 4-5 in Peking University First Hospital were prospectively collected. All the patients underwent transrectal ultrasound-guided cognitive fusion targeted biopsy (3 cores) followed by systematic biopsy (12 cores). Various hypothetical biopsy schemes were defined based on different biopsy sites. The detection effectiveness of targeted biopsy combined with regional systematic biopsy and other biopsy schemes for prostate cancer were compared using Cochran's and McNemar tests.
A total of 255 patients were enrolled, of whom 204 (80.0%) were detected with prostate adenocarcinoma and 187 (73.3%) were clinically significant with prostate cancer (csPCa). The detection rate of PCa with targeted biopsy was significantly lower than that of targeted biopsy combined with 12-core system biopsy (77.3% . 80.0%, =0.016), and 71.4% (5/7) of the missed patients was csPCa. There was no significant difference in the detection rate between targeted biopsy combined with 4-core regional system biopsy and 12-core system biopsy (>0.999), and 1 case of csPCa and clinically insignificant prostate cancer (cisPCa) were missed. There was no significant difference in the detection rate of PCa between targeted combined regional system biopsy and targeted combined lateral or traditional 6-core system biopsy and the number of cores were reduced. Missed diagnosis of targeted biopsy was correlated with the maximum diameter of the lesion (=0.086, 95%: 0.013-0.562, =0.010). For the patients with PI-RADS 5, only 1 case of PCa was missed in 122 cases by targeted biopsy alone. For patients with PI-RADS 4, 6 PCa cases were missed among the 133 patients with targeted biopsy alone, and 1 case of csPCa and cisPCa were missed by targeted biopsy combined with regional system biopsy. The statistics of positive core counts for different biopsy schemes indicated that targeted combined regional systematic biopsy had a higher proportion of positive cores second only to targeted biopsy alone.
Targeted biopsy combined with regional systematic biopsy has high diagnostic efficacy in patients with PI-RADS 4-5 and can be considered as one of the improved schemes for combined biopsy. Targeted biopsy alone is also a feasible option for patients for patients with a PI-RADS score of 5.
探讨靶向活检联合区域系统性活检对前列腺影像报告和数据系统v2.1（PI-RADS v2.1）4-5级前列腺癌（PCa）患者的诊断效能。
前瞻性收集2023年1月至2023年10月在北京大学第一医院首次接受前列腺活检、总前列腺特异性抗原（tPSA）≤20 ng/mL且多参数磁共振成像（mpMRI）PI-RADS为4-5级的患者。所有患者均接受经直肠超声引导下的认知融合靶向活检（3针），随后进行系统性活检（12针）。根据不同活检部位定义了各种假设活检方案。采用 Cochr an检验和McNemar检验比较靶向活检联合区域系统性活检及其他活检方案对前列腺癌的检测效能。
共纳入255例患者，其中204例（80.0%）检测出前列腺腺癌，187例（73.3%）为临床有意义的前列腺癌（csPCa）。靶向活检对PCa的检出率显著低于靶向活检联合12针系统活检（77.3% 对80.0%，P = 0.016），漏诊的患者中有71.4%（5/7）为csPCa。靶向活检联合4针区域系统活检与12针系统活检的检出率差异无统计学意义（P>0.999），漏诊1例csPCa和1例临床无意义前列腺癌（cisPCa）。靶向联合区域系统活检与靶向联合外侧或传统6针系统活检相比，PCa检出率差异无统计学意义，且活检针数减少。靶向活检漏诊与病灶最大直径相关（P = 0.086，95%CI：0.013 - 0.562，P = 0.010）。对于PI-RADS 5级患者，单纯靶向活检122例中仅漏诊1例PCa。对于PI-RADS 4级患者，单纯靶向活检133例中漏诊6例PCa，靶向活检联合区域系统活检漏诊1例csPCa和1例cisPCa。不同活检方案阳性针数统计显示，靶向联合区域系统性活检阳性针数比例仅次于单纯靶向活检。
靶向活检联合区域系统性活检对PI-RADS 4-5级患者具有较高诊断效能，可作为联合活检的改进方案之一。对于PI-RADS评分为5的患者，单纯靶向活检也是一种可行选择。
