Sanguedolce Francesco, Lauwers Carol Nelly Gianna, Tedde Alessandro, Basile Giuseppe, Chernysheva Daria, Uleri Alessandro, Baboudjian Michael, Giannarini Gianluca, Panebianco Valeria, Madonia Massimo, Budäus Lars, Roupret Morgan, Palou Joan, Breda Alberto, Schoots Ivo, Padhani Anwar R
Fundació Puigvert, Department of Urology, Uro-Oncology Unit, Barcelona, Spain; Institut Reserca Sant Pau, Barcelona, Spain; Dipartimento di Medicina, Chirurgia e Farmacia, Universitá degli Studi di Sassari, Sassari, Italy.
Fundació Puigvert, Department of Urology, Uro-Oncology Unit, Barcelona, Spain; Dipartimento di Medicina, Chirurgia e Farmacia, Universitá degli Studi di Sassari, Sassari, Italy.
Eur Urol Oncol. 2025 Apr;8(2):534-543. doi: 10.1016/j.euo.2024.10.006. Epub 2024 Oct 24.
Intensification of targeted biopsy (TBx) around a magnetic resonance imaging (MRI)-visible lesion with regional biopsy (RBx) could obviate the need for systematic biopsy (SBx). We aimed to compare the detection yields of clinically significant prostate cancer (csPCa)-defined as International Society of Urological Pathology (ISUP) grade group ≥2-between TBx + RBx and the reference standard (TBx + SBx).
RBx was defined as perilesional or ipsilateral biopsy. A literature search was conducted up to September 2023 using PubMed, Embase, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Included studies were eligible when presenting data from SBx, TBx, and TBx + RBx cores and their detection yields. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria were used to assess the risk of bias of the included studies.
Twenty-one studies were included for a meta-analysis. The overall detection yield of csPCa was not statistically different between TBx + SBX and TBx + RBx (46.1% vs 44.2%; odds ratio [OR] 1.07, 95% confidence interval [CI] 0.99-1.16, p = 0.07); similar findings were found also for ISUP grade group ≥3 prostate cancer (PCa; OR 1.06, 95% CI 0.92-1.22, p = 0.43) and in different subgroup analyses. TBx + SBx was associated with higher cancer detection of ISUP grade group 1 PCa (OR 1.16, 95% CI 1.04-1.30, p = 0.008). The main limitations include the retrospective nature of most of the selected studies, heterogeneity of RBx definition, and template.
Our study supports the use of the TBx + RBx template in the early detection pathway for the detection of csPCa. SBx can be omitted when targeting lesions visible on MRI.
A prostate biopsy strategy consisting of taking biopsy in and around an magnetic resonance imaging-visible lesion reduces the risk of detecting indolent prostate cancers without affecting the detection of aggressive tumours.
在磁共振成像（MRI）可见病灶周围进行靶向活检（TBx）并结合区域活检（RBx）以强化活检，可能无需进行系统活检（SBx）。我们旨在比较TBx + RBx与参考标准（TBx + SBx）之间临床上显著前列腺癌（csPCa，定义为国际泌尿病理学会（ISUP）分级组≥2）的检出率。
RBx定义为病灶周围或同侧活检。截至2023年9月，使用PubMed、Embase和Web of Science数据库进行文献检索。遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。纳入的研究在呈现来自SBx、TBx和TBx + RBx样本及其检出率的数据时符合条件。使用诊断准确性研究的质量评估（QUADAS - 2）标准评估纳入研究的偏倚风险。
纳入21项研究进行Meta分析。TBx + SBX与TBx + RBx之间csPCa的总体检出率无统计学差异（46.1%对44.2%；优势比[OR]1.07，95%置信区间[CI]0.99 - 1.16，p = 0.07）；对于ISUP分级组≥3的前列腺癌（PCa；OR 1.06，95% CI 0.92 - 1.22，p = 0.43）以及在不同亚组分析中也发现了类似结果。TBx + SBx与ISUP分级组1的PCa更高的癌症检出率相关（OR 1.16，95% CI 1.04 - 1.30，p = 0.008）。主要局限性包括大多数所选研究的回顾性性质、RBx定义和模板的异质性。
我们的研究支持在csPCa的早期检测途径中使用TBx + RBx模板。在针对MRI可见病灶时可省略SBx。
一种由在磁共振成像可见病灶内及周围进行活检组成的前列腺活检策略，可降低检测惰性前列腺癌的风险，同时不影响侵袭性肿瘤的检测。
