Sattin Caterina, Pizzi Caterina, Summers Paul, Gaeta Aurora, Gandini Sara, Alessi Sarah, Nguyen Hoang Quyen, Renne Giuseppe, Luzzago Stefano, Marvaso Giulia, Musi Gennaro, Jereczek-Fossa Barbara Alicja, Padhani Anwar R, Petralia Giuseppe
Postgraduate School of Radiodiagnostics, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy.
Division of Radiology, European Institute of Oncology IRCCS, Milan, Italy.
Radiology. 2025 Jul;316(1):e241710. doi: 10.1148/radiol.241710.
Background MRI-targeted biopsies are recommended for prostate cancer diagnosis. In-bore MRI-targeted biopsy enables high-precision needle placement; however, the factors affecting prostate cancer detection rates and the potential for grade and patient risk migration require further investigation. Purpose To evaluate factors affecting the detection rate of prostate cancer in patients who underwent in-bore MRI-targeted biopsy and their influence on histologic concordance between biopsy (bGG) and surgical grade group (sGG). Materials and Methods This retrospective study evaluated in-bore MRI-targeted biopsies performed between March 2015 and January 2023. The agreement between bGG and sGG was assessed using Cohen weighted κ. The detection rate of prostate cancer and the concordance rates between bGG and sGG in patients undergoing prostatectomy were compared between biopsy systems (manual and robotic) and by patient biopsy status, lesion size (≤10 mm vs >10 mm), and Prostate Imaging Reporting and Data System (PI-RADS) category. Results In total, 780 lesions (patient median age, 65 years [IQR, 59-70 years]) were included. Among patients with previous negative biopsy and biopsy-naive patients, the detection rates of grade group (GG) 2 or higher cancer were higher in patients with PI-RADS category 4 or higher lesions (42.5% and 46.5%) and lesions larger than 10 mm (45.1% and 43.4%) ( < .05). Surgical upgrading was higher in lesions with bGG 1 than in those with bGG 2-4 cancers (66.1% vs 16.0% [ < .001]). In the 216 patients undergoing radical prostatectomy, bGG and sGG showed moderate to substantial agreement (weighted κ correlation coefficient, 0.61 [95% CI: 0.51, 0.71]). A downgrade of two or more grades between bGG and sGG was rare (5.7%). Histopathologic concordance did not depend on the PI-RADS category, target lesion size, biopsy system, or patient biopsy status ( = .90). Conclusion The in-bore MRI-targeted biopsy detection rates for GG 2 or higher prostate cancer depend on the target lesion size and PI-RADS category, and there is a substantial risk of histologic upgrades in men with GG 1 lesions at MRI-targeted biopsy. © RSNA, 2025 See also the editorial by Milot in this issue.
背景 推荐采用磁共振成像（MRI）靶向活检进行前列腺癌诊断。孔内MRI靶向活检能够实现高精度的穿刺针定位；然而，影响前列腺癌检出率的因素以及分级和患者风险转移的可能性仍需进一步研究。目的 评估接受孔内MRI靶向活检患者中影响前列腺癌检出率的因素及其对活检分级（bGG）与手术分级组（sGG）之间组织学一致性的影响。材料与方法 这项回顾性研究评估了2015年3月至2023年1月期间进行的孔内MRI靶向活检。采用Cohen加权κ评估bGG与sGG之间的一致性。比较活检系统（手动和机器人）以及患者活检状态、病变大小（≤10 mm与>10 mm）和前列腺影像报告和数据系统（PI-RADS）类别对接受前列腺切除术患者的前列腺癌检出率以及bGG与sGG之间的一致性率。结果 共纳入780个病变（患者中位年龄65岁[四分位间距，59 - 70岁]）。在既往活检阴性的患者和未接受过活检的患者中，PI-RADS类别为4级或更高的病变（42.5%和46.5%）以及大于10 mm的病变（45.1%和43.4%）中2级或更高分级癌症的检出率更高（P <.05）。bGG为1级的病变手术升级率高于bGG为2 - 4级癌症的病变（66.1%对16.0%[P <.001]）。在216例行根治性前列腺切除术的患者中，bGG与sGG显示出中度至高度一致性（加权κ相关系数，0.61[95%CI：0.51，0.71]）。bGG与sGG之间降低两级或更多级别的情况很少见（5.7%）。组织病理学一致性不取决于PI-RADS类别、目标病变大小、活检系统或患者活检状态（P =.90）。结论 孔内MRI靶向活检对2级或更高分级前列腺癌的检出率取决于目标病变大小和PI-RADS类别，且在MRI靶向活检中，bGG为1级病变的男性存在显著的组织学升级风险。©RSNA，2025 另见本期Milot的社论。
