Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy.
Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy.
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DOI：
10.1016/j.eururo.2013.05.059
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发表时间：
2013-11
期刊：
影响因子：
23.4
通讯作者：
Pinto PA
中科院分区：
文献类型：
--
作者：
Siddiqui MM;Rais-Bahrami S;Truong H;Stamatakis L;Vourganti S;Nix J;Hoang AN;Walton-Diaz A;Shuch B;Weintraub M;Kruecker J;Amalou H;Turkbey B;Merino MJ;Choyke PL;Wood BJ;Pinto PA
从历史上看，标准 12 芯前列腺活检的格里森评分在 25-33% 的患者中得到了升级。多参数前列腺磁共振成像 (MP-MRI) 结合超声 (US) 靶向融合活检可以更好地对真实的腺体病理进行采样。将 MRI/US 融合引导的前列腺活检平台的格里森评分升级率与单独的标准 12 芯活检方案进行比较。 2007 年 8 月至 2012 年 8 月期间，共有 582 名受试者参加了一项前瞻性试验，该试验将系统性扩展 12 芯经直肠超声活检与同一活检期间进行的靶向 MRI/US 融合引导前列腺活检进行比较。比较了每种活检方法的最高格里森评分。具有电磁跟踪功能的 MRI/US 融合引导平台用于进行融合引导活检。 315 名 (54%) 患者被诊断为前列腺癌 (PCa)。添加靶向活检导致 81 例 (32%) 病例进行格里森升级。与单独的 12 芯活检相比，靶向活检检测到的 Gleason ≥4 + 3 肿瘤多了 67%，漏掉了 36% 的 Gleason ≤3 + 4 肿瘤，从而减少了低级别疾病的检测。相反，与单独的靶向活检相比，12 芯活检使 67 (26%) 例病例得到升级，但仅检测到的 Gleason ≥4 + 3 肿瘤多了 8%。在多变量分析中，MP-MRI 怀疑与目标病变的格里森评分升级相关（p < 0.001）。这项研究的主要局限性是无法获得根治性前列腺切除术的明确病理学结果。与传统的单独 12 芯活检相比，MRI/US 融合引导活检升级并在 32% 的患者中检测出具有更高格里森评分的 PCa。靶向活检技术优先检测较高级别的 PCa，同时漏掉较低级别的肿瘤。
Gleason scores from standard, 12-core prostate biopsies are upgraded historically in 25−33% of patients. Multiparametric prostate magnetic resonance imaging (MP-MRI) with ultrasound (US)-targeted fusion biopsy may better sample the true gland pathology. The rate of Gleason score upgrading from an MRI/US-fusion-guided prostate-biopsy platform is compared with a standard 12-core biopsy regimen alone. There were 582 subjects enrolled from August 2007 through August 2012 in a prospective trial comparing systematic, extended 12-core transrectal ultrasound biopsies to targeted MRI/US-fusion-guided prostate biopsies performed during the same biopsy session. The highest Gleason score from each biopsy method was compared. An MRI/US-fusion-guided platform with electromagnetic tracking was used for the performance of the fusion-guided biopsies. A diagnosis of prostate cancer (PCa) was made in 315 (54%) of the patients. Addition of targeted biopsy led to Gleason upgrading in 81 (32%) cases. Targeted biopsy detected 67% more Gleason ≥4 + 3 tumors than 12-core biopsy alone and missed 36% of Gleason ≤3 + 4 tumors, thus mitigating the detection of lower-grade disease. Conversely, 12-core biopsy led to upgrading in 67 (26%) cases over targeted biopsy alone but only detected 8% more Gleason ≥4 + 3 tumors. On multivariate analysis, MP-MRI suspicion was associated with Gleason score upgrading in the targeted lesions (p < 0.001). The main limitation of this study was that definitive pathology from radical prostatectomy was not available. MRI/US-fusion-guided biopsy upgrades and detects PCa of higher Gleason score in 32% of patients compared with traditional 12-core biopsy alone. Targeted biopsy technique preferentially detects higher-grade PCa while missing lower-grade tumors.
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