Richart Valèria, Costa Meritxell, Muní María, Asiain Ignacio, Salvador Rafael, Puig Josep, Rodriguez-Carunchio Leonardo, Salinas Belinda, Comas-Cufí Marc, Nicolau Carlos
Radiology Department, Hospital Clinic, 08036 Barcelona, Spain.
Urology Department, Hospital Clinic, 08036 Barcelona, Spain.
Cancers (Basel). 2025 Aug 22;17(17):2735. doi: 10.3390/cancers17172735.
: Magnetic resonance imaging (MRI) and MRI-ultrasound (US) fusion-targeted biopsy have improved prostate cancer diagnosis, particularly for clinically significant disease. However, the added value of combining systematic biopsy with targeted biopsy remains debated. This study aimed to evaluate the diagnostic accuracy of MRI-US fusion-targeted and systematic transperineal biopsies in detecting prostate cancer and explore the correlation between PI-RADS score and histology. : We retrospectively analyzed 356 patients with 452 MRI-detected lesions who underwent both MRI-US fusion-targeted and transperineal systematic biopsies between 2020 and 2023. Clinically significant prostate cancer (csPCa) was defined as International Society of Urological Pathology (ISUP) grade ≥ 2. Diagnostic performance metrics (sensitivity, specificity, and accuracy) were calculated for each technique using the combined result as a reference. Subgroup analysis was performed for patients under active surveillance. : Prostate cancer was diagnosed in 323 of 452 lesions (71%) and csPCa in 223 lesions (49%). Targeted biopsy demonstrated higher sensitivity (93.7%) and accuracy (79.9%) than systematic biopsy (85.7% sensitivity and 77.6% accuracy), although systematic biopsy provided slightly higher specificity. Systematic biopsy alone identified 8.2% of PCa cases missed by targeted biopsy and upgraded 9.9% of lesions to csPCa. csPCa detection increased with PI-RADS score (23% in PI-RADS 3 and 73% in PI-RADS 5). In active surveillance patients, csPCa was found in 65% of lesions. : MRI-US fusion-targeted biopsy improves csPCa detection, but systematic biopsy remains valuable, especially for identifying additional or higher-grade disease. The combined approach provides an optimal diagnostic yield, supporting its continued use in both initial and repeat biopsy settings.
磁共振成像（MRI）和MRI-超声（US）融合靶向活检改善了前列腺癌的诊断，尤其是对于具有临床意义的疾病。然而，将系统活检与靶向活检相结合的附加价值仍存在争议。本研究旨在评估MRI-US融合靶向和经会阴系统活检在检测前列腺癌方面的诊断准确性，并探讨PI-RADS评分与组织学之间的相关性。我们回顾性分析了2020年至2023年间接受MRI-US融合靶向活检和经会阴系统活检的356例患者，这些患者共有452个MRI检测到的病变。具有临床意义的前列腺癌（csPCa）定义为国际泌尿病理学会（ISUP）分级≥2级。以联合结果为参考，计算每种技术的诊断性能指标（敏感性、特异性和准确性）。对接受主动监测的患者进行亚组分析。452个病变中有323个（71%）诊断为前列腺癌，223个病变（49%）诊断为csPCa。靶向活检显示出比系统活检更高的敏感性（93.7%）和准确性（79.9%）（系统活检的敏感性为85.7%，准确性为77.6%），尽管系统活检的特异性略高。单独的系统活检发现了靶向活检遗漏的8.2%的前列腺癌病例，并将9.9%的病变升级为csPCa。csPCa的检测率随PI-RADS评分增加（PI-RADS 3为23%，PI-RADS 5为73%）。在接受主动监测的患者中，65%的病变发现了csPCa。MRI-US融合靶向活检提高了csPCa的检测率，但系统活检仍然有价值，特别是对于识别额外的或更高分级的疾病。联合方法提供了最佳的诊断率，支持其在初次活检和重复活检中继续使用。
