Geometric evaluation of systematic transrectal ultrasound guided prostate biopsy.
Geometric evaluation of systematic transrectal ultrasound guided prostate biopsy.
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DOI：
10.1016/j.juro.2012.07.107
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发表时间：
2012-12
影响因子：
6.6
通讯作者：
Stoianovici, Dan
中科院分区：
文献类型：
--
作者：
Han, Misop;Chang, Doyoung;Kim, Chunwoo;Lee, Brian J.;Zuo, Yihe;Kim, Hyung-Joo;Petrisor, Doru;Trock, Bruce;Partin, Alan W.;Rodriguez, Ronald;Carter, H. Ballentine;Allaf, Mohamad;Kim, Jongwon;Stoianovici, Dan
经直肠超声引导的前列腺活检结果依赖于医生根据活检方案定位腺体的能力。然而，据我们所知，徒手经直肠超声引导活检芯放置在前列腺中的准确性以及活检芯的几何分布如何影响前列腺癌的检出率尚不清楚。为了确定核心的几何分布，我们开发了一个活检模拟系统，包括骨盆模型和光学跟踪系统。由5名泌尿科医生和我们的经直肠超声机器人以徒手方式对模型进行活检，该机器人可以支撑和移动经直肠超声探头。我们比较了1)靶向错误，2)重复活检的准确性和精确性，以及3)使用基于概率的模型估计显著前列腺癌（0.5 cm3或更大）的检出率。泌尿科医生以集群模式对核心进行了活检，并对前列腺的重要部分进行了取样。机器人严格遵循预定义的活检方案。泌尿科医生和机器人的平均瞄准误差分别为9.0和1.0 mm。机器人辅助显著减少重复活检错误，提高准确性和精密度。泌尿科医生和机器人的前列腺癌平均显著检出率分别为36%和43% （p <0.0001）。徒手经直肠超声引导下的系统活检不严格遵循六分仪模式，可能导致不理想的采样和癌症检测。对同一目标重复徒手活检是具有挑战性的。机器人辅助优化活检方案可以潜在地提高靶向性、精度和准确性。需要一项临床试验来证实机器人辅助的额外好处。
Transrectal ultrasound guided prostate biopsy results rely on physician ability to target the gland according to the biopsy schema. However, to our knowledge it is unknown how accurately the freehand, transrectal ultrasound guided biopsy cores are placed in the prostate and how the geometric distribution of biopsy cores may affect the prostate cancer detection rate. To determine the geometric distribution of cores, we developed a biopsy simulation system with pelvic mock-ups and an optical tracking system. Mock-ups were biopsied in a freehand manner by 5 urologists and by our transrectal ultrasound robot, which can support and move the transrectal ultrasound probe. We compared 1) targeting errors, 2) the accuracy and precision of repeat biopsies, and 3) the estimated significant prostate cancer (0.5 cm3 or greater) detection rate using a probability based model. Urologists biopsied cores in clustered patterns and under sampled a significant portion of the prostate. The robot closely followed the predefined biopsy schema. The mean targeting error of the urologists and the robot was 9.0 and 1.0 mm, respectively. Robotic assistance significantly decreased repeat biopsy errors with improved accuracy and precision. The mean significant prostate cancer detection rate of the urologists and the robot was 36% and 43%, respectively (p <0.0001). Systematic biopsy with freehand transrectal ultrasound guidance does not closely follow the sextant schema and may result in suboptimal sampling and cancer detection. Repeat freehand biopsy of the same target is challenging. Robotic assistance with optimized biopsy schemas can potentially improve targeting, precision and accuracy. A clinical trial is needed to confirm the additional benefits of robotic assistance.
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影响因子：
--
作者：
Kepner GR;Kepner JV
通讯作者：
Kepner JV
DOI：
10.1016/j.urolonc.2011.02.014
发表时间：
2011-05
期刊：
Urologic oncology
影响因子：
--
作者：
Natarajan S;Marks LS;Margolis DJ;Huang J;Macairan ML;Lieu P;Fenster A
通讯作者：
Fenster A
影响因子：
2.1
作者：
Norberg, M;Egevad, L;Busch, C
通讯作者：
Busch, C
影响因子：
6.6
作者：
Borboroglu, PG;Comer, SW;Amling, CL
通讯作者：
Amling, CL
DOI：
10.1093/jnci/djm119
发表时间：
2007-09-19
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Welch, H. Gilbert;Fisher, Elliott S.;Barry, Michael J.
通讯作者：
Barry, Michael J.