Riskin-Jones Hannah H, Raman Alex G, Kulkarni Rushikesh, Arnold Corey W, Sisk Anthony, Felker Ely, Lu David S, Marks Leonard S, Raman Steven S
University of California, Los Angeles, Los Angeles, USA.
Abdom Radiol (NY). 2025 Jan 18. doi: 10.1007/s00261-024-04753-3.
We analyzed the additional value of systematic biopsy (SB) to MR-Ultrasound fusion biopsy (MRgFbx) for detection of clinically significant prostate cancer (csPCa), as increased sampling may cause increased morbidity.
This retrospective study cohort was comprised of 1229 biopsy sessions between July 2016 and May 2020 in men who had a Prostate Imaging-Reporting and Data System (PI-RADSv2) category ≥ 3 lesion on 3 Tesla multiparametric MRI (3TmpMRI) and subsequent combined biopsy (CB; MRgFbx and SB) for suspected prostate cancer (PCa). Cancer detection rates (CDR) were calculated for CB, MRgFbx and SB in the study cohort and sub-cohorts stratified by biopsy history and PI-RADSv2 category. For 927 men with unilateral MR-visible lesions, SB CDR was additionally calculated for contralateral (SBc) and ipsilateral (SBi) subcohorts.
On CB, the CDR for csPCa was 54.8% (673/1229). CDR for csPCa was significantly higher for MRgFbx (50.0%, CI 47.1-52.8%) compared to SB (35.3%, CI 32.6-38.1%) for all PI-RADSv2 ≥ 3 categories (p < .05). The MRgFbx CDR for PI-RADSv2 categories 3, 4, and 5 were 81.5%, 88.5%, and 95.6% respectively. For unilateral lesion cases, significantly more csPCa was detected in the SBi compared to the SBc subcohort (30.1% (279/927) vs. 10.4%, (96/927), p < 0.001). The combination of MRgFbx and SBi detected csPCa in 97.0% (480) of the 495 csPCa detected by CB.
MRgFbx had a higher CDR for csPCa than SB. While CB detected more csPCa than either method alone, in patients with a PI-RADSv2 category of 5, MRgFbx approximated the performance of CB. In unilateral lesion cases, SBc provided minimal added benefit.
我们分析了系统活检（SB）相对于磁共振-超声融合活检（MRgFbx）在检测临床显著前列腺癌（csPCa）方面的附加价值，因为增加采样可能会导致发病率上升。
本回顾性研究队列包括2016年7月至2020年5月期间1229例活检病例，这些男性在3特斯拉多参数磁共振成像（3TmpMRI）上有前列腺影像报告和数据系统（PI-RADSv2）分类≥3级的病变，并因疑似前列腺癌（PCa）接受了联合活检（CB；MRgFbx和SB）。计算了研究队列以及按活检史和PI-RADSv2分类分层的亚队列中CB、MRgFbx和SB的癌症检测率（CDR）。对于927例有单侧磁共振可见病变的男性，还分别计算了对侧（SBc）和同侧（SBi）亚队列的SB CDR。
在CB中，csPCa的CDR为54.8%（673/1229）。对于所有PI-RADSv2≥3级分类，MRgFbx检测csPCa的CDR（50.0%，CI 47.1 - 52.8%）显著高于SB（35.3%，CI 32.6 - 38.1%）（p < 0.05）。PI-RADSv2分类为3、4和5级的MRgFbx CDR分别为81.5%、88.5%和95.6%。对于单侧病变病例，SBi亚队列中检测到的csPCa显著多于SBc亚队列（30.1%（279/927）对10.4%（96/927），p < 0.001）。CB检测到的495例csPCa中，MRgFbx和SBi联合检测出97.0%（480例）。
MRgFbx检测csPCa的CDR高于SB。虽然CB检测到的csPCa比单独使用任何一种方法都多，但在PI-RADSv2分类为5级的患者中，MRgFbx的表现接近CB。在单侧病变病例中，SBc提供的附加益处最小。
