Norberg M, Egevad L, Holmberg L, Sparén P, Norlén B J, Busch C
Department of Diagnostic Radiology, University Hospital, Uppsala, Sweden.
Urology. 1997 Oct;50(4):562-6. doi: 10.1016/S0090-4295(97)00306-3.
The aim of this prospective study was to evaluate the sensitivity of the sextant biopsy protocol compared with a more extensive procedure for the detection of prostate cancer and to define a biopsy model with the minimal number of biopsies necessary to maintain diagnostic accuracy.
A total of 512 consecutive patients with suspected prostate cancer were examined with transrectal ultrasound (TRUS) and underwent TRUS-guided core biopsy. All patients had 8 or 10 standardized biopsy samples taken, with the number depending on the size of the gland. Additional biopsy samples were taken from hypoechoic or hyperechoic lesions located outside the predetermined location for the standardized biopsies (ie, target biopsies). The sensitivity of the detection of cancer for different combinations of biopsy samples was analyzed and compared with that of our model with 8 to 10 biopsies.
In all, 276 cancers were detected, of which 88 (32%) had an isoechoic appearance. Sensitivity was 59% for focal lesions detected by TRUS, 85% to 97% for different combinations of systematic biopsy samples, and 93% to 98% for a combination of systematic and target biopsy samples. The sensitivity for the standard sextant protocol was 85%. By adding target biopsies, the sensitivity increased to 93%.
The standard sextant protocol leaves 15% of cancers undetected compared with results obtained from a more extensive biopsy procedure. By combining systematic and target sampling, the sensitivity increases; however, a major concern is that the clinical importance of cancers detected by multiple biopsies needs to be evaluated.
本前瞻性研究旨在评估六分区活检方案与更广泛的活检程序相比，在检测前列腺癌方面的敏感性，并确定一种活检模型，该模型所需的活检次数最少，同时能保持诊断准确性。
对512例连续怀疑患有前列腺癌的患者进行经直肠超声（TRUS）检查，并接受TRUS引导下的穿刺活检。所有患者均采集8或10份标准化活检样本，样本数量取决于前列腺大小。另外，从标准化活检预定位置之外的低回声或高回声病变处（即靶向活检）采集活检样本。分析不同活检样本组合检测癌症的敏感性，并与我们8至10次活检的模型进行比较。
总共检测出276例癌症，其中88例（32%）呈等回声表现。TRUS检测到的局灶性病变的敏感性为59%，系统性活检样本不同组合的敏感性为85%至97%，系统性和靶向活检样本组合的敏感性为93%至98%。标准六分区方案的敏感性为85%。通过增加靶向活检，敏感性提高到93%。
与更广泛的活检程序相比，标准六分区方案会漏诊15%的癌症。通过结合系统性和靶向采样，敏感性提高；然而，一个主要问题是需要评估多次活检检测出的癌症的临床重要性。
