Netaji Arjunlokesh, Kubihal Vijay, Sharma Raju, Seth Amlesh, Kaushal Seema, Das Chandan J
Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Radiol Imaging. 2024 Dec 11;35(3):387-394. doi: 10.1055/s-0044-1796642. eCollection 2025 Jul.
The aim of this study was to compare the sensitivity and prostate cancer detection rate of magnetic resonance (MR) in-bore biopsy with transrectal ultrasound (TRUS) guided systematic biopsy. We also compared the cancer detection rate of the combined MR in-bore and TRUS-guided systematic biopsy with the TRUS-guided biopsy only approach. In this prospective study, 61 consecutive patients with prostate-specific antigen (PSA) ≥ 3 ng/mL and Prostate Imaging Reporting and Data System (PI-RADS) score ≥4 were recruited between July 2017 and January 2020. One patient with prior prostate surgery was excluded. Among the remaining 60 patients, 30 underwent MR in-bore biopsy followed by systematic biopsy (study arm A) and 30 underwent systematic biopsy only (study arm B). The mean PSA range of study population ( = 60 patients) was 4.2 to 72.7 ng/mL. Twenty-seven patients had a PI-RADS score of 4, and 33 patients had a PI-RADS score of 5. Among 60 patients, 30 had prostate carcinoma on biopsy, of which 18 were clinically significant prostate cancers (csPCa). In study arm A, TRUS-guided systematic biopsy had a lower sensitivity (0.9) for detection of csPCa compared with MR in-bore biopsy (1.0) with overdetection of insignificant cancers (sensitivity: 0.89 vs. 0.56). TRUS-guided biopsy yielded 112 positive cores out of 360, whereas MR in-bore biopsy yielded 15 positive cores out of 30 (31.1 vs. 50%; = 0.03). On comparison of study arms A and B, the diagnostic yield for detection of both prostate cancer and csPCa were high in study arm A (60 vs. 40%, and 33.3 vs. 26.7%, respectively) MRI in-bore targeted biopsy had a greater sensitivity to detect csPCa with fewer number of biopsy cores and lower sensitivity to detect insignificant cancers compared with systematic biopsy. Systematic biopsies were associated with overdetection of clinically insignificant cancers.
本研究的目的是比较磁共振（MR）腔内活检与经直肠超声（TRUS）引导下系统活检的敏感性及前列腺癌检测率。我们还比较了MR腔内联合TRUS引导下系统活检与单纯TRUS引导下活检的癌症检测率。
在这项前瞻性研究中，2017年7月至2020年1月期间，连续招募了61例前列腺特异性抗原（PSA）≥3 ng/mL且前列腺影像报告和数据系统（PI-RADS）评分≥4的患者。1例曾接受过前列腺手术的患者被排除。在其余60例患者中，30例接受了MR腔内活检，随后进行系统活检（研究组A），30例仅接受系统活检（研究组B）。
研究人群（n = 60例患者）的平均PSA范围为4.2至72.7 ng/mL。27例患者的PI-RADS评分为4，33例患者的PI-RADS评分为5。60例患者中，30例活检发现患有前列腺癌，其中有18例为临床显著性前列腺癌（csPCa）。在研究组A中，与MR腔内活检（敏感性为1.0）相比，TRUS引导下系统活检检测csPCa的敏感性较低（0.9），且存在对非显著性癌症的过度检测（敏感性：0.89对0.56）。TRUS引导下活检在360个穿刺针芯中有112个阳性，而MR腔内活检在30个穿刺针芯中有15个阳性（31.1%对50%；P = 0.03）。比较研究组A和B，研究组A中前列腺癌和csPCa的诊断率均较高（分别为60%对40%，33.3%对26.7%）。
与系统活检相比，MR腔内靶向活检检测csPCa的敏感性更高，所需活检针芯数量更少，检测非显著性癌症的敏感性更低。系统活检与临床非显著性癌症的过度检测相关。
