Magnetic Resonance Imaging-Transectal Ultrasound Image-fusion Biopsies Accurately Characterize the Index Tumor: Correlation with Step-sectioned Radical Prostatectomy Specimens in 135 Patients
Magnetic Resonance Imaging-Transectal Ultrasound Image-fusion Biopsies Accurately Characterize the Index Tumor: Correlation with Step-sectioned Radical Prostatectomy Specimens in 135 Patients
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DOI：
10.1016/j.eururo.2014.08.077
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发表时间：
2015-04-01
期刊：
影响因子：
23.4
通讯作者：
Gill, Inderbir S.
中科院分区：
文献类型：
--
作者：
Baco, Eduard;Ukimura, Osamu;Gill, Inderbir S.
背景资料：通过磁共振（MR）和三维（3D）经直肠超声（TRUS）图像的弹性融合进行靶向前列腺活检可以准确识别指数肿瘤（IT），其定义为具有最高Gleason评分或最大体积或前列腺外延伸的病变。目的：确定MR-TRUS图像融合活检在表征IT方面的准确性，并通过与分步根治性直肠癌切除术（RP）标本的相关性进行证实。设计，设置和参与者：回顾性分析了2010年1月至2013年9月期间在两个中心依次接受活检前MR、MR-TRUS图像融合活检和机器人RP的135例连续患者。干预：通过实时3D TRUS跟踪对MR疑似IT病变进行图像引导活检。最大的地理上不同的癌症病灶结果测量和统计分析：使用一个包括27个感兴趣区域的有效模式来识别MR图像和RP标本中的IT中心位置，以及活检轨迹中点的位置，并将变量进行相关性分析。结果和限制：活检标本与RP标本的IT位置符合率为95%（128/135）。MRI上IT体积与组织学之间的相关系数为r = 0.663（p < 0.001）。活检的最大癌芯长度与RP肿瘤体积弱相关（r = 0.466，p < 0.001）。靶向活检与RP标本原发性Gleason分型的一致性为90%（115/128; k = 0.76）。该研究的局限性包括对选定患者人群的回顾性评价，这限制了结果的普遍性。结论：使用MR-TRUS图像融合引导前列腺活检可靠地确定了>90%患者IT病变的位置和原发性Gleason模式，但显示出有限的预测癌症体积的能力，如阶梯切片RP标本所证实的。使用磁共振图像结合实时三维经直肠超声进行靶向活检，使我们能够可靠地识别前列腺癌中最重要肿瘤的空间位置并表征其侵袭性。(C)2014年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: Prostate biopsies targeted by elastic fusion of magnetic resonance (MR) and three-dimensional (3D) transrectal ultrasound (TRUS) images may allow accurate identification of the index tumor (IT), defined as the lesion with the highest Gleason score or the largest volume or extraprostatic extension.Objective: To determine the accuracy ofMR-TRUS image-fusion biopsy in characterizing ITs, as confirmed by correlation with step-sectioned radical prostatectomy (RP) specimens.Design, setting, and participants: Retrospective analysis of 135 consecutive patients who sequentially underwent pre-biopsy MR, MR-TRUS image-fusion biopsy, and robotic RP at two centers between January 2010 and September 2013.Intervention: Image-guided biopsies of MR-suspected IT lesions were performed with tracking via real-time 3D TRUS. The largest geographically distinct cancer focus (IT lesion) was independently registered on step-sectioned RP specimens.Outcome measurements and statistical analysis: A validated schema comprising 27 regions of interest was used to identify the IT center location on MR images and in RP specimens, as well as the location of the midpoint of the biopsy trajectory, and variables were correlated.Results and limitations: The concordance between IT location on biopsy and RP specimens was 95% (128/135). The coefficient for correlation between IT volume on MRI and histology was r = 0.663 (p < 0.001). The maximum cancer core length on biopsy was weakly correlated with RP tumor volume (r = 0.466, p < 0.001). The concordance of primary Gleason pattern between targeted biopsy and RP specimens was 90% (115/128; k = 0.76). The study limitations include retrospective evaluation of a selected patient population, which limits the generalizability of the results.Conclusion: Use of MR-TRUS image fusion to guide prostate biopsies reliably identified the location and primary Gleason pattern of the IT lesion in >90% of patients, but showed limited ability to predict cancer volume, as confirmed by step-sectioned RP specimens.Patient summary: Biopsies targeted using magnetic resonance images combined with real-time three-dimensional transrectal ultrasound allowed us to reliably identify the spatial location of the most important tumor in prostate cancer and characterize its aggressiveness. (C) 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.