Daneshgari F, Taylor G D, Miller G J, Crawford E D
Department of Pathology, University of Colorado Health Sciences Center, Denver, USA.
Urology. 1995 Apr;45(4):604-9. doi: 10.1016/S0090-4295(99)80051-X.
Six random systematic core biopsies (SRSCB) of the prostate (biopsies from apex, middle, and base of each lobe) have been commonly used in detection of prostate carcinoma. The objective of this study was to verify the validity of the SRSCB technique in detecting cancer in prostates with low-volume tumor (less than 6 cc).
We developed a computer model of the prostate to simulate the SRSCB technique. The data for development of this model were taken from 159 radical prostatectomy specimens in which 112 patients had tumor volumes measured and in which 91 prostates had tumors with volumes less than 6 cc (by whole-mount sectioning).
The simulation shows that only 20.3% of the simulated prostates, with total aggregate tumor volume between 0.034 and 5.1 cc, had a tumor distribution for which the SRSCB technique has a 95% probability of detecting the tumor. In fact, 26.8% had a tumor distribution that was completely disjointed from the six recommended biopsy regions. To compare these results with other possible occurrence, various biases for the angle of biopsy and the distribution of cancer foci were incorporated into the model. Study results should be viewed with the understanding that any simulated model has its limitations. In our simulated model, the shape of the simulated tumor foci (spherical) does not represent all the possible shapes of prostate cancer. However, these results indicate that detection of cancer with biopsies taken from the apex, middle, and base of each lobe of a prostate with tumor volumes of less than 6 cc may not be as effective as it is in prostates with larger tumor volumes or patients with an abnormal digital rectal examination. The study of bias models suggests that the distributional pattern of cancerous foci can have a significant impact on the effectiveness of a given biopsy strategy.
We concluded that future attempts to improve systematic biopsy strategies for detection of low-volume cancer should include biomechanical characteristics of prostate cancer, including gland volume and tumor distribution. Driven by the conclusions from this idealized model, we have developed a three-dimensional model of the prostate gland from its whole-mount histologic maps. It is anticipated that this continuing investigation will lead to realistic guidelines for improving biopsy techniques.
前列腺六点随机系统穿刺活检（SRSCB）（取自每个叶的尖部、中部和基底部的活检组织）常用于前列腺癌的检测。本研究的目的是验证SRSCB技术在检测小体积肿瘤（小于6立方厘米）前列腺癌中的有效性。
我们开发了一个前列腺计算机模型来模拟SRSCB技术。该模型开发的数据取自159例根治性前列腺切除术标本，其中112例患者测量了肿瘤体积，91例前列腺肿瘤体积小于6立方厘米（通过全切片）。
模拟显示，在总肿瘤体积介于0.034至5.1立方厘米之间的模拟前列腺中，只有20.3%的肿瘤分布使得SRSCB技术有95%的概率检测到肿瘤。实际上，26.8%的肿瘤分布与六个推荐活检区域完全不相交。为了将这些结果与其他可能情况进行比较，模型纳入了活检角度和癌灶分布的各种偏差。应认识到任何模拟模型都有其局限性，以此来审视研究结果。在我们的模拟模型中，模拟肿瘤灶的形状（球形）并不代表前列腺癌所有可能的形状。然而，这些结果表明，对于肿瘤体积小于6立方厘米的前列腺，从每个叶的尖部、中部和基底部进行活检来检测癌症，可能不如在肿瘤体积较大的前列腺或直肠指检异常的患者中那样有效。偏差模型研究表明，癌灶的分布模式对给定活检策略的有效性可能有显著影响。
我们得出结论，未来为改进检测小体积癌症的系统活检策略所做的尝试应包括前列腺癌的生物力学特征，包括腺体体积和肿瘤分布。受此理想化模型结论的驱动，我们根据全切片组织学图谱开发了前列腺三维模型。预计这项持续的研究将产生改进活检技术的实用指南。
