Orecchia Luca, Germani Stefano, Colalillo Gaia, Fasano Angelica, Ricci Matteo, Rosato Eleonora, Asimakopoulos Anastasios D, Albisinni Simone, Finazzi Agrò Enrico, Manenti Guglielmo, Miano Roberto
Urology Unit AOU Policlinico Tor Vergata University Hospital Rome Italy.
Department of Surgical Sciences University of Rome Tor Vergata Rome Italy.
BJUI Compass. 2024 Nov 10;5(12):1288-1298. doi: 10.1002/bco2.462. eCollection 2024 Dec.
The objective of this study is to evaluate the diagnostic performance of perineal access cannulas tethered to a biplanar ultrasound probe in cognitive transperineal prostate biopsies of targets identified by multiparametric magnetic resonance imaging (mpMRI) by comparing the results of the PrecisionPoint (PP) Transperineal Access System with the double-freehand (DFH) technique.
All patients who underwent cognitive transperineal prostate biopsy of mpMRI targets using the PP or DFH technique between November 2020 and September 2023 were enrolled. All data related to mpMRI target biopsies were stratified by technique, visibility in transrectal ultrasound and analysed by comparing PP versus DFH. A standardised anaesthesia protocol with 1% mepivacaine was used in all biopsies. The tolerability of the procedures was assessed using a visual analogue scale (VAS).
The number of mpMRI targets sampled was 166 in PP and 242 in DFH. In target biopsies, the PP system was associated with better diagnostic performance for clinically significant prostate cancer (Gleason score ≥3 + 4) compared to DFH for both ultrasound-visible targets (61.4% vs. 48.0%) and non-visible targets (41.4% vs. 14.9%) ( = 0.02). A higher rate of positive cores was obtained from targets sampled with PP (57.7% vs. 49.6%, = 0.0002). The PP system was associated with the retrieval of significantly longer cores ( < 0.0001). There was no significant difference between the techniques regarding pain reported during the biopsy, with a median VAS of 2.7/10, although the PP device required a lower amount of anaesthetic in the periprostatic planes (4.3 ± 2.0 mL vs. 5.9 ± 1.9 mL, < 0.0001).
The PrecisionPoint Transperineal Access System enabled more precise and higher quality biopsies, resulting in improved histological characterisation of prostate cancer compared to the DFH approach. The use of a perineal cannula did not increase the pain perceived by patients and also required less local anaesthetic during the biopsy.
本研究的目的是通过比较PrecisionPoint（PP）经会阴穿刺系统与双手自由操作（DFH）技术的结果，评估在多参数磁共振成像（mpMRI）识别的目标的认知性经会阴前列腺活检中，连接双平面超声探头的会阴穿刺套管的诊断性能。
纳入2020年11月至2023年9月期间使用PP或DFH技术对mpMRI目标进行认知性经会阴前列腺活检的所有患者。所有与mpMRI目标活检相关的数据按技术分层，经直肠超声下的可见性，并通过比较PP与DFH进行分析。所有活检均采用含1%甲哌卡因的标准化麻醉方案。使用视觉模拟量表（VAS）评估操作的耐受性。
PP组mpMRI目标采样数量为166个，DFH组为242个。在目标活检中，对于超声可见目标（61.4%对48.0%）和不可见目标（41.4%对14.9%），与DFH相比，PP系统对临床显著前列腺癌（Gleason评分≥3 + 4）具有更好的诊断性能（P = 0.02）。PP采样的目标获得的阳性核心率更高（57.7%对49.6%，P = 0.0002）。PP系统与获取明显更长的核心相关（P < 0.0001）。活检期间报告的疼痛在两种技术之间无显著差异，VAS中位数为2.7/10，尽管PP装置在前列腺周围平面所需的麻醉剂用量较少（4.3 ± 2.0 mL对5.9 ± 1.9 mL，P < 0.0001）。
与DFH方法相比，PrecisionPoint经会阴穿刺系统能够进行更精确、更高质量的活检，从而改善前列腺癌的组织学特征。使用会阴套管不会增加患者感知的疼痛，并且在活检期间所需的局部麻醉剂也更少。
