USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, CA.
USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Urol Oncol. 2025 Jan;43(1):64.e1-64.e10. doi: 10.1016/j.urolonc.2024.08.002. Epub 2024 Aug 22.
To evaluate the learning curve of a transperineal (TP) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion prostate biopsy (PBx).
Consecutive patients undergoing MRI followed by TP PBx from May/2017 to January/2023, were prospectively enrolled (IRB# HS-13-00663). All participants underwent MRI followed by 12 to 14 core systematic PBx (SB), with at least 2 additional targeted biopsy (TB) cores per PIRADS ≥3. The biopsies were performed transperineally using an organ tracking image-fusion system. The cohort was divided into chronological quintiles. An inflection point analysis was performed to determine proficiency. Operative time was defined from insertion to removal of the TRUS probe from the patient's rectum. Grade Group ≥2 defined clinically significant prostate cancer (CSPCa). Statistically significant if P < 0.05.
A total of 370 patients were included and divided into quintiles of 74 patients. MRI findings and PIRADS distribution were similar between quintiles (P = 0.08). The CSPCa detection with SB+TB was consistent across quintiles: PIRADS 1 and 2 (range, 0%-18%; P = 0.25); PIRADS 3 to 5 (range, 46%-70%; P = 0.12). The CSPCa detection on PIRADS 3 to 5 TB alone, for quintiles 1 to 5, was respectively 44%, 58%, 66%, 41%, and 53% (P = 0.08). The median operative time significantly decreased for PIRADS 1 and 2 (33 min to 13 min; P < 0.01) and PIRADS 3 to 5 (48 min to 19 min; P < 0.01), reaching a plateau after 156 cases. Complications were not significantly different across quintiles (range, 0-5.4%; P = 0.3).
The CSPCa detection remained consistently satisfactory throughout the learning curve of the Transperineal MRI/TRUS fusion prostate biopsy. However, the operative time significantly decreased with proficiency achieved after 156 cases.
评估经会阴（TP）磁共振成像（MRI）和经直肠超声（TRUS）融合前列腺活检（PBx）的学习曲线。
2017 年 5 月至 2023 年 1 月，前瞻性纳入连续接受 MRI 检查后行 TP PBx 的患者（IRB# HS-13-00663）。所有患者均接受 MRI 检查，随后进行 12-14 核系统 PBx（SB），至少有 2 个 PIRADS≥3 的靶向活检（TB）核心。活检经会阴使用器官跟踪图像融合系统进行。该队列按时间顺序分为五等分。进行拐点分析以确定熟练程度。手术时间定义为 TRUS 探头从患者直肠插入到移除的时间。Grades Group≥2 定义为有临床意义的前列腺癌（CSPCa）。如果 P<0.05，则表示具有统计学意义。
共纳入 370 例患者，分为 74 例患者的五分位数。MRI 结果和 PIRADS 分布在五分位数之间相似（P=0.08）。SB+TB 的 CSPCa 检出率在五分位数之间一致：PIRADS 1 和 2（范围，0%-18%；P=0.25）；PIRADS 3-5（范围，46%-70%；P=0.12）。对于五分位数 1-5，单独进行 PIRADS 3-5 TB 的 CSPCa 检出率分别为 44%、58%、66%、41%和 53%（P=0.08）。对于 PIRADS 1 和 2（33 分钟至 13 分钟；P<0.01）和 PIRADS 3-5（48 分钟至 19 分钟；P<0.01），操作时间中位数显著降低，在完成 156 例后达到平台期。并发症在五分位数之间无显著差异（范围，0-5.4%；P=0.3）。
经会阴 MRI/TRUS 融合前列腺活检的学习曲线过程中，CSPCa 的检出率始终保持令人满意。然而，随着 156 例操作后熟练程度的提高，手术时间显著缩短。
