Karakiewicz P I, Hanley J A, Bazinet M
Department of Urology, McGill University, Montreal, Quebec, Canada.
Urology. 1998 Aug;52(2):208-12. doi: 10.1016/s0090-4295(98)00175-7.
To assess the relationship between tumor volume, gland volume, number of sectors submitted to biopsy, and prostatic biopsy detection rate.
Using a three-dimensional mathematical model of the prostate, we assessed detection rates achieved with 4-, 6-, 8-, 10-, and 12-sector biopsies for glands ranging from 20 to 100 cc and peripheral zone tumors ranging from 0.3 to 1.4 cc.
Quadrant and sextant biopsy approaches only yielded from 6.2% to 13.4% and 8.6% to 18.3%, respectively, of lesions in a 40-cc gland. Conversely, 10- and 12-sector approaches yielded, respectively, from 19.8% to 48.8% and 25.4% to 62% of lesions for the same gland size. When assessed according to the density of sampling, one biopsy core used for every 1 .5 to 3.5 cc of prostatic tissue detected 42.5% of 0.5-cc lesions. For the same lesion size, the density of sampling per biopsy core was then decreased to intervals extending from 3.6 to 7.5 cc, 7.6 to 12.5 cc, and 12.6 to 25 cc. These sampling density intervals yielded, respectively, 25.0%, 15.8%, and 9.8% detection rates.
On the basis of our results, a gland volume-based biopsy algorithm is likely to result in improved detection of clinically significant prostate cancer.
评估肿瘤体积、腺体体积、活检取材的扇区数量与前列腺活检检出率之间的关系。
我们使用前列腺的三维数学模型，评估了针对体积在20至100立方厘米的腺体以及体积在0.3至1.4立方厘米的外周区肿瘤，采用4扇区、6扇区、8扇区、10扇区和12扇区活检时的检出率。
对于一个40立方厘米的腺体，象限活检法和六分法活检法分别仅能检出6.2%至13.4%和8.6%至18.3%的病变。相反，对于相同大小的腺体，10扇区和12扇区活检法分别能检出19.8%至48.8%和25.4%至62%的病变。根据取材密度评估，每1.5至3.5立方厘米前列腺组织使用1个活检针芯可检出42.5%的0.5立方厘米病变。对于相同的病变大小，随后将每个活检针芯的取材密度区间扩大至3.6至7.5立方厘米、7.6至12.5立方厘米以及12.6至25立方厘米。这些取材密度区间的检出率分别为25.0%、15.8%和9.8%。
基于我们的研究结果，一种基于腺体体积的活检算法可能会提高临床显著前列腺癌的检出率。
