Abstract：
BACKGROUND: To define the smallest prostate needle biopsy (PNB) template necessary for accurate tissue diagnosis in men with markedly elevated PSA while decreasing procedural morbidity.
METHODS: We performed a chart review of 80 men presenting with a newly elevated PSA > 100 ng/mL who underwent biopsy (PNB or metastatic site). For patients who underwent a full 12-core biopsy, simulated templates of 2- to 10-cores were generated by randomly drawing subsets of biopsies from their full-template findings. Templates were iterated to randomize core location and generate theoretical smaller template outcomes. Simulated biopsy results were compared to full-template findings to determine accuracy to maximal Grade Group (GG) diagnosis.
RESULTS: Amongst those that underwent PNB, 93% had GG 4 or 5 disease. Twenty-two (40%) underwent a full 12-core biopsy, 20 (37%) a 6-core biopsy, and only 8 (15%) had fewer than six biopsy cores sampled at our hospital. Simulated templates with 2-, 4-, 6-, and 8-cores correctly diagnosed prostate cancer in all patients, and accurately identified the maximal GG in 82%, 91%, 95%, and 97% of patients, respectively. The biopsy locations most likely to detect maximal GG were medial mid and base sites bilaterally. A 4-core template of these sites would have accurately detected the maximal GG in 95% of patients relative to a full 12-core template.
CONCLUSIONS: In men presenting with PSA > 100 ng/mL, decreasing from a 12-core to a 4-core prostate biopsy template results in universal cancer detection and minimal under-grading while theoretically decreasing procedural morbidity and cost.
METHODS: We performed a chart review of 80 men presenting with a newly elevated PSA > 100 ng/mL who underwent biopsy (PNB or metastatic site). For patients who underwent a full 12-core biopsy, simulated templates of 2- to 10-cores were generated by randomly drawing subsets of biopsies from their full-template findings. Templates were iterated to randomize core location and generate theoretical smaller template outcomes. Simulated biopsy results were compared to full-template findings to determine accuracy to maximal Grade Group (GG) diagnosis.
RESULTS: Amongst those that underwent PNB, 93% had GG 4 or 5 disease. Twenty-two (40%) underwent a full 12-core biopsy, 20 (37%) a 6-core biopsy, and only 8 (15%) had fewer than six biopsy cores sampled at our hospital. Simulated templates with 2-, 4-, 6-, and 8-cores correctly diagnosed prostate cancer in all patients, and accurately identified the maximal GG in 82%, 91%, 95%, and 97% of patients, respectively. The biopsy locations most likely to detect maximal GG were medial mid and base sites bilaterally. A 4-core template of these sites would have accurately detected the maximal GG in 95% of patients relative to a full 12-core template.
CONCLUSIONS: In men presenting with PSA > 100 ng/mL, decreasing from a 12-core to a 4-core prostate biopsy template results in universal cancer detection and minimal under-grading while theoretically decreasing procedural morbidity and cost.
摘要：
背景：为了定义最小的前列腺穿刺活检（PNB）模板，对于PSA明显升高的男性患者进行准确的组织诊断，同时降低手术发病率。
方法：我们对80名接受活检（PNB或转移部位）的新PSA升高>100ng/mL的男性进行了图表回顾。对于接受完整12核活检的患者，通过从全模板结果中随机抽取活检的子集,生成2~10个核心的模拟模板.迭代模板以随机化核心位置并生成理论上较小的模板结果。将模拟活检结果与全模板结果进行比较,以确定最大等级组(GG)诊断的准确性。
结果：在接受PNB的患者中，93%有GG4或5病。22人（40%）接受了完整的12核活检，20（37%）6核活检，只有8个(15%)在我们医院取样的活检核心少于6个.模拟模板与2-,4-,6-，在所有患者中正确诊断出8核前列腺癌，并准确地确定了82%的最大GG，91%,95%,97%的病人,分别。最有可能检测到最大GG的活检位置是两侧的中间和基部。相对于完整的12核模板，这些位点的4核模板将在95％的患者中准确检测到最大GG。
结论：在PSA>100ng/mL的男性中，从12核减少到4核前列腺活检模板导致普遍的癌症检测和最小的低分级,同时理论上降低了手术发病率和成本.
方法：我们对80名接受活检（PNB或转移部位）的新PSA升高>100ng/mL的男性进行了图表回顾。对于接受完整12核活检的患者，通过从全模板结果中随机抽取活检的子集,生成2~10个核心的模拟模板.迭代模板以随机化核心位置并生成理论上较小的模板结果。将模拟活检结果与全模板结果进行比较,以确定最大等级组(GG)诊断的准确性。
结果：在接受PNB的患者中，93%有GG4或5病。22人（40%）接受了完整的12核活检，20（37%）6核活检，只有8个(15%)在我们医院取样的活检核心少于6个.模拟模板与2-,4-,6-，在所有患者中正确诊断出8核前列腺癌，并准确地确定了82%的最大GG，91%,95%,97%的病人,分别。最有可能检测到最大GG的活检位置是两侧的中间和基部。相对于完整的12核模板，这些位点的4核模板将在95％的患者中准确检测到最大GG。
结论：在PSA>100ng/mL的男性中，从12核减少到4核前列腺活检模板导致普遍的癌症检测和最小的低分级,同时理论上降低了手术发病率和成本.
