目的:研究各种减核前列腺活检方案对MRI可见病变(前列腺成像报告和数据系统≥3)患者临床显著前列腺癌(csPCa)检测的影响。
方法:共招募464例MRI可见病灶患者。所有患者均接受两次或更多次靶向活检(TB)和系统活检(SB)。建立了几种假设的活检方案:仅结核病,TB+同侧SB,TB+对侧SB,目标部门的TB+SB(TB+t-SB),和非目标扇区的TB+SB(TB+n-SB)。对具有多个MRI可见病变的患者进行亚组分析。参考标准定义为TB+SB。McNemar检验用于比较各种采样方案之间的csPCa检测率。
结果:前列腺癌和csPCa的检出率分别为72.8%(464中的338)和62.1%(464中的288),分别。有8.0%,0.3%,6.3%,1.0%,只有4.5%的结核病病例,TB+同侧SB,TB+对侧SB,TB+t-SB,TB+n-SB会错过csPCa,分别。所有假设的计划,除TB+对侧SB(p=0.063)外,在csPCa检测方面显著优于单独的TB(p<0.05)。至于多焦点队列,其中包括48例,在同一患者中,无一例非指标病变的Gleason分级高于指标病变.
结论:TB+同侧SB可能是检测csPCa的最佳活检方案。至于多焦点队列,非指标病变的活检提供的病理信息有限.
To investigate the effects of various prostate biopsy protocols with reduced cores on the detection of clinically significant prostate cancer (csPCa) in individuals with MRI-visible lesions (Prostate Imaging Reporting and Data System ≥ 3).
A total of 464 patients with MRI-visible lesions were recruited. All patients underwent two or more targeted biopsies (TB) and systematic biopsies (SB). Several hypothetical biopsy schemes were set-up: TB alone, TB+ipsilateral SB, TB+contralateral SB, TB+SB of the targeted sector (TB+t-SB), and TB+SB of the non-targeted sector (TB+n-SB). A subgroup analysis of patients with multiple MRI-visible lesions was performed. The standard of reference was defined as TB+SB. McNemar test was used to compare csPCa detection rates between various sampling schemes.
The detection rates for prostate cancer and csPCa were 72.8% (338 of 464) and 62.1% (288 of 464), respectively. There were 8.0%, 0.3%, 6.3%, 1.0%, and 4.5% cases in which TB alone, TB+ipsilateral SB, TB+contralateral SB, TB+t-SB, and TB+n-SB would have missed csPCa, respectively. All hypothetical schemes, with the exception of TB+contralateral SB (p = 0.063), significantly outperformed TB alone in terms of csPCa detection (p < 0.05). As for the multi-focus cohort, which included 48 cases, none of the non-index lesions had a higher Gleason grade than the index lesions within the same patients.
TB+ipsilateral SB might be the optimal biopsy scheme for detecting csPCa. As for the multi-focus cohort, the biopsy of the non-index lesions provided limited pathological information.