磁共振成像(MRI)靶向活检改变了前列腺癌诊断的教条。活检可以经直肠(MRI引导和经直肠超声融合经直肠活检[MRI-TRUSB])或经会阴(MRI引导和经直肠超声融合经会阴活检[MRI-TPB])进行。
评估MRI-TRUSB和MRI-TPB的检出率和并发症发生率。
我们在PubMed进行了文献检索,Scopus,EMBASE,中央,以及比较MRI-TRUSB与MRI-TPB的随机对照试验(RCTs)和观察性研究。
我们的搜索确定了3608项研究;我们在定性中包括了5项,在定量合成中包括了2项。对每位患者进行临床上有意义的前列腺癌(csPCa)的汇总分析,MRI-TPB检出率明显更高(相对危险度1.28[95%置信区间{CI}1.03-1.60],p=0.03)。在每个病变分析中,MRI-TPB前csPCa检出率显著高于统计学(相对危险度2.46[95%CI1.22-4.98],p=0.01)。在每个病变分析中,MRI-TPB和MRI-TRUSB总体癌症检出率分别为75%和81.6%(p=0.53),CSPCa检出率分别为65.7%和75.5%(p=0.40),分别。MRI-TPB的并发症发生率较低(比值比2.56[95%CI1.14-5.56,p<0.05])。关于建议评估的分级,发展,和评估(等级)评估,我们将所有结果评定为“非常低”的证据确定性。
这篇综述强调了缺乏比较MRI-TPB和MRI-TRUSB的高质量证据。MRI-TPB可以更好地检测csPCa,前部肿瘤,和较低的感染并发症。虽然RCT是可以解决现有证据限制的最高质量的证据,对于与MRI-TRUSB相关的感染性并发症存在担忧.因此,作者建议研究人员和临床医生通过维护前瞻性数据库来采用务实的方法,MRI-TPB方法的内部审计,并将这些数据与历史MRI-TRUSB队列进行比较。
我们通过比较磁共振成像(MRI)引导和经直肠超声融合经直肠活检与MRI引导和经直肠超声融合经会阴活检(TPB)来观察结果。分析表明,基于非常低的确定性证据,MRI-TPB对有临床意义的前列腺癌有更好的检测,前部肿瘤,低并发症。
Magnetic resonance imaging (MRI)-targeted biopsies have changed the dogma in prostate cancer diagnosis. Biopsies can be performed either transrectally (MRI-guided and transrectal ultrasound fusion transrectal biopsy [MRI-TRUSB]) or transperineally (MRI-guided and transrectal ultrasound fusion transperineal biopsy [MRI-TPB]).
To evaluate the detection and complication rates of MRI-TRUSB and MRI-TPB.
We performed a literature search in PubMed, Scopus, EMBASE, and CENTRAL, and selected randomized controlled trials (RCTs) and observational studies comparing MRI-TRUSB versus MRI-TPB.
Our search identified 3608 studies; we included five in the qualitative and two in the quantitative synthesis. On per-patient pooled analysis for clinically significant prostate cancer (csPCa), MRI-TPB detection rates were significantly higher (relative risk 1.28 [95% confidence interval {CI} 1.03-1.60], p = 0.03). On a per-lesion analysis, MRI-TPB anterior csPCa detection rates were statistically significantly higher (relative risk 2.46 [95% CI 1.22-4.98], p = 0.01). On a per-lesion analysis, MRI-TPB and MRI-TRUSB overall cancer detection rates were 75% and 81.6% (p= 0.53), and csPCa detection rates were 65.7% and 75.5% (p = 0.40), respectively. MRI-TPB had lower complication rates (odds ratio 2.56 [95% CI 1.14-5.56, p < 0.05]). On Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evaluation, we rated all outcomes as \"very low\" certainty of the evidence for all outcome measures.
This
review highlights the paucity of good-quality evidence comparing MRI-TPB and MRI-TRUSB. MRI-TPB achieves better detection for csPCa, anterior tumors, and lower infective complications. While RCTs are the highest quality of evidence that can address existing evidence limitations, there are concerns regarding infective complications associated with the MRI-TRUSB. Therefore, the authors propose that researchers and clinicians adopt a pragmatic approach by maintaining prospective databases, internal auditing of the MRI-TPB approach, and comparing these data with historical MRI-TRUSB cohorts.
We looked at the outcomes by comparing magnetic resonance imaging (MRI)-guided and transrectal ultrasound fusion transrectal biopsy with MRI-guided and transrectal ultrasound fusion transperineal biopsy (TPB). The analysis suggests, based on very low certainty evidence, that MRI-TPB has better detection for clinically significant prostate cancer, anterior tumors, and lower complications.