Nian Yongsheng, Xu Qiuya, Cheng Yongbing, Li Danyan, Zhu Li, Huang Haifeng, Fu Yao, Peng Shan, Guo Hongqian, Qiu Xuefeng
Department of Urology, Affiliated Hospital of Medical School, Institute of Urology, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, 210009, China.
Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210009, China.
World J Urol. 2025 Aug 5;43(1):476. doi: 10.1007/s00345-025-05759-2.
The objective of this study was to evaluate the diagnostic efficacy of combining prostate targeted biopsy (TB) with ipsilateral systematic biopsy (iSB) for men with unilateral index lesion on magnetic resonance imaging (MRI).
This single-center, retrospective study included 654 patients with unilateral index lesion (PI-RADS ≥ 3) on MRI who underwent prostate target biopsy combined with 12-core systematic biopsy (SB) between January 2022 to February 2023. The index lesion was defined as the lesion with the highest PI-RADS score or, in cases of multiple lesions with the same highest score, the one with the largest diameter. Ipsilateral systematic biopsy (iSB) was defined as the hemi-lateral systematic biopsy on the same side as the index lesion on MRI, while contralateral systematic biopsy (cSB) was defined as the hemi-lateral systematic biopsy on the opposite side. Kappa consistency analysis was conducted to compare the csPCa detection rates between TB combined with SB (TB + SB) and TB combined with iSB (TB + iSB). The McNemar test was used to compare the csPCa detection rates between TB + iSB and TB + cSB.
The csPCa detection rate was higher for TB + iSB than for TB + cSB (44.87% vs. 42.73%, P < 0.01). TB + iSB showed greater consistency with TB + SB than TB + cSB (K = 0.975 vs. 0.932). Stratified analysis revealed similar results across PI-RADS scores, PSA levels (< 20 ng/ml), age, and prostate volumes, except for PSA levels > 20 ng/ml (66.67% vs. 68.9%, P < 0.01).
TB + iSB, which omits half of the SB cores, demonstrates extremely high consistency with TB + SB in detecting csPCa in men with unilateral index lesion on MRI, and has a higher csPCa detection rate compared to TB + cSB, indicating its potential to replace TB + SB.
本研究的目的是评估前列腺靶向活检（TB）与同侧系统活检（iSB）相结合对磁共振成像（MRI）显示有单侧索引病变的男性的诊断效能。
这项单中心回顾性研究纳入了2022年1月至2023年2月期间654例MRI显示有单侧索引病变（前列腺影像报告和数据系统（PI-RADS）≥3）且接受了前列腺靶向活检联合12针系统活检（SB）的患者。索引病变定义为PI-RADS评分最高的病变，或者在多个病变具有相同最高评分的情况下，定义为直径最大的病变。同侧系统活检（iSB）定义为与MRI上索引病变同侧的半侧系统活检，而对侧系统活检（cSB）定义为与索引病变相对侧的半侧系统活检。进行Kappa一致性分析以比较TB联合SB（TB+SB）和TB联合iSB（TB+iSB）之间临床显著性前列腺癌（csPCa）的检出率。采用McNemar检验比较TB+iSB和TB+cSB之间csPCa的检出率。
TB+iSB的csPCa检出率高于TB+cSB（44.87%对42.73%，P<0.01）。与TB+cSB相比，TB+iSB与TB+SB的一致性更高（K=0.975对0.932）。分层分析显示，除了PSA水平>20 ng/ml（66.67%对68.9%，P<0.01）外，在PI-RADS评分、PSA水平（<20 ng/ml）、年龄和前列腺体积方面结果相似。
省略一半SB针数的TB+iSB在检测MRI显示有单侧索引病变男性的csPCa方面与TB+SB具有极高的一致性，并且与TB+cSB相比具有更高的csPCa检出率，表明其有取代TB+SB的潜力。
