对于 MRI 和微超声在影像学上存在不一致的病变而未经活检的患者，临床显著前列腺癌检出率：一项单中心回顾性分析。
Clinically significant prostate cancer detection rate in biopsy-naïve patients with mpMRI and microultrasound topographically discordant lesions: A single-center retrospective analysis.
机构信息
Department of Urology, Humanitas Research Hospital - IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University -Pieve Emanuele, Italy.
Department of Urology, University College London Hospital NHS Foundation Trust, London, UK.
出版信息
Urol Oncol. 2024 Dec;42(12):447.e11-447.e16. doi: 10.1016/j.urolonc.2024.06.021. Epub 2024 Jul 26.
INTRODUCTION AND OBJECTIVES
Multiparametric magnetic resonance imaging (mpMRI) has improved the detection of clinically significant prostate cancer (csPCa), and microultrasound (micro-US) shows promise in enhancing detection rates. We compared mpMRI-guided targeted biopsy (MTBx) and micro-US-guided targeted biopsy (micro-US-TBx) in biopsy-naïve patients with discordant lesions at micro-US and mpMRI to detect csPCa (grade group ≥2) and clinically insignificant PCa (ciPCa; grade group 1) and assessed the role of nontargeted systematic biopsy (SBx).
MATERIAL AND METHODS
We analyzed 178 biopsy-naive men with suspected PCa and discordant lesions at mpMRI and micro-US. All patients underwent mpMRI followed by micro-US, the latter being performed immediately before the biopsy. Imaging findings were interpreted blindly, followed by targeted and SBx. Median age was 63 years (IQR, 57-70), median prostate-specific antigen level was 7 ng/mL (IQR, 5-9 ng/mL), and median prostate volume was 49 cm^3 (IQR, 35-64 cm^3). Overall, 86/178 (48%) patients were diagnosed with PCa, 51/178 (29%) with csPCa.
RESULTS
Micro-USTBx detected csPCa in 36/178 men (20%; 95% CI: 26-46), and MTBx detected csPCa in 28/178 men (16%; 95% CI: 36-50), resulting in a -8% difference (95% CI: -10, 4; P = 0.022) and a relative detection rate of 0.043. Micro-USTBx detected ciPCa in 9/178 men (5%; 95% CI: 3, 15), while MTBx detected ciPCa in 12/178 men (7%; 95% CI: 5, 20), resulting in a -3% difference (95% CI: -2 to 4; P = 0.2) and a relative detection rate of 0.1. SBx detected ciPCa in 29 (16%) men. mpMRI plus micro-US detected csPCa in 51/178 men, with no additional cases with the addition of SBx. Similarly, MTBx plus micro-USTBx plus SBx detected ciPCa in 35/178 men (20%; 95% CI: 18, 37) compared to 9 (5%) in the micro-US pathway (P = 0.002) and 14/178 (8%; 95% CI: 6, 26) in the mpMRI plus micro-US pathway (P = 0.004).
CONCLUSIONS
In conclusion, a combined micro-US/mpMRI approach could characterize primary disease in biopsy-naïve patients with discordant lesions, potentially avoiding SBx. Further studies are needed to validate our findings and assess micro-US's role in reducing unnecessary biopsies.
介绍和目的
多参数磁共振成像（mpMRI）提高了临床显著前列腺癌（csPCa）的检出率，而微超声（micro-US）在提高检出率方面显示出了潜力。我们比较了 mpMRI 引导的靶向活检（MTBx）和 micro-US 引导的靶向活检（micro-US-TBx）在 micro-US 和 mpMRI 存在不一致病变的活检初治患者中检测 csPCa（分级组≥2）和临床意义不大的前列腺癌（ciPCa；分级组 1）的效果，并评估了非靶向系统活检（SBx）的作用。
材料和方法
我们分析了 178 例疑似前列腺癌且 mpMRI 和 micro-US 存在不一致病变的活检初治男性患者。所有患者均接受了 mpMRI 检查，随后进行了 micro-US 检查，后者在活检前立即进行。影像学检查结果进行盲法解读，随后进行靶向活检和 SBx。中位年龄为 63 岁（IQR，57-70），中位前列腺特异性抗原水平为 7ng/mL（IQR，5-9ng/mL），中位前列腺体积为 49cm³（IQR，35-64cm³）。总体而言，178 例患者中有 86 例（48%）被诊断为前列腺癌，51 例（29%）为 csPCa。
结果
micro-US-TBx 检测到 178 例患者中有 36 例（20%；95%CI：26-46）为 csPCa，MTBx 检测到 178 例患者中有 28 例（16%；95%CI：36-50）为 csPCa，差异为-8%（95%CI：-10，4；P=0.022），相对检出率为 0.043。micro-US-TBx 检测到 178 例患者中有 9 例（5%；95%CI：3，15）为 ciPCa，而 MTBx 检测到 178 例患者中有 12 例（7%；95%CI：5，20）为 ciPCa，差异为-3%（95%CI：-2 至 4；P=0.2），相对检出率为 0.1。SBx 检测到 29 例（16%）患者为 ciPCa。mpMRI 联合 micro-US 检测到 178 例患者中有 51 例（30%）为 csPCa，而 SBx 则未检测到更多 csPCa 病例。同样，MTBx 联合 micro-US-TBx 联合 SBx 检测到 178 例患者中有 35 例（20%；95%CI：18，37）为 ciPCa，而 micro-US 路径仅检测到 9 例（5%）（P=0.002），mpMRI 联合 micro-US 路径仅检测到 14 例（8%）（P=0.004）。
结论
总之，micro-US/mpMRI 联合方法可以对存在不一致病变的活检初治患者的原发性疾病进行特征描述，可能避免 SBx。需要进一步研究来验证我们的发现，并评估 micro-US 在减少不必要的活检方面的作用。
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