Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: The role of systematic and targeted biopsies.
Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: The role of systematic and targeted biopsies.
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DOI：
10.1002/cncr.29874
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发表时间：
2016-03-15
期刊：
影响因子：
6.2
通讯作者：
Marks LS
中科院分区：
文献类型：
--
作者：
Filson CP;Natarajan S;Margolis DJ;Huang J;Lieu P;Dorey FJ;Reiter RE;Marks LS
评价磁共振（MR）-超声引导融合活检在诊断临床显著前列腺癌（csCaP）中的性能。在一项前瞻性试验（2009 - 2014）中，1042名男性连续接受了多参数MRI（mpMRI）和融合活检。专家阅片员使用已发表的方案对mpMRI感兴趣区域（ROI）进行了1 - 5级评分。使用融合活检器械从ROI（存在时）获得靶向核心，然后对所有男性进行融合图像引导的12核心系统活检，即使没有可疑ROI。主要终点是检测临床显著的CaP（即，Gleason评分≥ 7）。在825名有≥ 1个3级或以上可疑ROI的男性中，289名（35%）患有csCaP。csCaP的强有力预测因子是ROI分级（5级vs 3级，OR 6.5，p <0.01）和前列腺特异性抗原密度（每增加0.05 ng/mL/cc，OR 1.4，p <0.01）。结合系统和靶向活检检测到更多的csCaP（n = 289）比靶向（n = 229）或系统活检单独（n = 199）。在没有可疑ROI的患者中，35例（16%）在系统活检中有csCaP。在这项前瞻性试验中，MR超声融合活检允许检测csCaP，与ROI等级和PSA密度直接相关。靶向和系统活检的组合检测到更多的csCaP比任何一种方式单独;系统活检显示csCaP在16%的男性没有可疑的MRI目标。这种新的活检方法的优点是显而易见的，但在广泛采用之前，成本，培训和可靠性的问题有待解决。
To evaluate performance of magnetic resonance (MR)-ultrasound guided fusion biopsy in diagnosing clinically significant prostate cancer (csCaP). 1042 men underwent multi-parametric MRI (mpMRI) and fusion biopsy consecutively in a prospective trial (2009 – 2014). An expert reader graded mpMRI regions of interest (ROI) 1–5 using published protocols. The fusion biopsy device was used to obtain targeted cores from ROIs (when present) followed by a fusion-image guided 12-core systematic biopsy in all men, even if no suspicious ROI. Primary endpoint was detection of clinically significant CaP (i.e., Gleason score ≥ 7). Among 825 men with ≥ 1 suspicious ROI of grade 3 or higher, 289 (35%) had csCaP. Powerful predictors of csCaP were ROI grade (grade 5 vs 3, OR 6.5, p<0.01) and prostate-specific antigen density (each increase of 0.05 ng/mL/cc, OR 1.4, p<0.01). Combining systematic and targeted biopsies detected more csCaP (n=289) than targeting (n=229) or systematic biopsy alone (n=199). Among patients with no suspicious ROI, 35 (16%) had csCaP on systematic biopsy. In this prospective trial, MR-ultrasound fusion biopsy allowed detection of csCaP with a direct relationship with ROI grade and PSA density. The combination of targeted and systematic biopsy detected more csCaP than either modality alone; systematic biopsies revealed csCaP in 16% of men with no suspicious MRI target. Advantages of this new biopsy method are apparent, but issues of cost, training, and reliability await resolution prior to widespread adoption.