背景:前列腺的磁共振成像-经直肠超声(MRI-TRUS)-融合活检(FBx)允许对前列腺内的可疑病变进行针对性采样,通过多参数MRI识别。由于其可靠的结果和可行性,会阴MRI/TRUSFBx现在是前列腺癌(PC)诊断的金标准。市场上有各种用于执行FBx的系统,例如,基于软件,半机器人,或机器人辅助平台解决方案。他们的半自动工作流程保证了独立于外科医生经验的高过程质量。这项研究的目的是分析外科医生的经验如何通过靶向活检(TB)影响癌症检出率(CDR)和手术在机器人辅助FBx的持续时间。
方法:分析了在2015年10月至2022年4月之间进行机器人辅助FBx采样的1716名男性。我们回顾性地从患者的电子病历中提取数据。主要终点是TB的CDR和程序的持续时间。对于我们的分析,外科医生分为三个经验级别:≤20次手术(少),21-100程序(中间),和>100程序(高)。通过回归分析和组比较进行统计分析。
结果:年龄中位数,前列腺特异性抗原水平,该队列的前列腺体积为67(±7.7)年,8.13(±9.4)ng/mL,53(±34.2)mL,分别。手术的中位持续时间为26(±10.9)分钟。随着外科医生的经验从35.1(很少的经验)增加到28.4(中等经验)到24.0分钟(高经验)(p<0.001),持续时间显着减少。仅使用TB,872/1758(49.6%)的男性中诊断出明显的PC(sPC)。CDR显示,在组比较(p=0.907)或回归分析(p=0.65)中,与外科医生的经验均无显著相关性。
结论:虽然此手术的持续时间随着经验的增加而减少,TB中sPC的检出率与外科医生执行机器人辅助FBx的经验无显著相关.因此,这种机器人辅助活检系统的诊断准确性似乎与经验无关。
BACKGROUND: Magnetic resonance imaging-transrectal ultrasound (MRI-TRUS)-fusion biopsy (FBx) of the prostate allows targeted sampling of suspicious lesions within the prostate, identified by multiparametric MRI. Due to its reliable results and feasibility, perineal MRI/TRUS FBx is now the gold standard for prostate cancer (PC) diagnosis. There are various systems for performing FBx on the market, for example, software-based, semirobotic, or robot-assisted platform solutions. Their semiautomated workflow promises high process quality independent of the surgeon\'s experience. The aim of this study was to analyze how the surgeon\'s experience influences the cancer detection rate (CDR) via targeted biopsy (TB) and the procedure\'s duration in robot-assisted FBx.
METHODS: A total of 1716 men who underwent robot-assisted FBx involving a combination of targeted and systematic sampling between October 2015 and April 2022 were analyzed. We extracted data from the patients\' electronic medical records retrospectively. Primary endpoints were the CDR by TB and the procedure\'s duration. For our analysis, surgeons were divided into three levels of experience: ≤20 procedures (little), 21-100 procedures (intermediate), and >100 procedures (high). Statistical analysis was performed via regression analyses and group comparisons.
RESULTS: Median age, prostate-specific antigen level, and prostate volume of the cohort were 67 (±7.7) years, 8.13 (±9.4) ng/mL, and 53 (±34.2) mL, respectively. Median duration of the procedure was 26 (±10.9) min. The duration decreased significantly with the surgeon\'s increasing experience from 35.1 (little experience) to 28.4 (intermediate experience) to 24.0 min (high experience) (p < 0.001). Using TB only, significant PC (sPC) was diagnosed in 872/1758 (49.6%) of the men. The CDR revealed no significant correlation with the surgeon\'s experience in either group comparison (p = 0.907) or in regression analysis (p = 0.65).
CONCLUSIONS: While the duration of this procedure decreases with increasing experience, the detection rate of sPC in TB is not significantly associated with the experience of the surgeon performing robot-assisted FBx. This robot-assisted biopsy system\'s diagnostic accuracy therefore appears to be independent of experience.