Diagnostic Performance of Initial Transperineal Template-guided Mapping Biopsy of the Prostate Gland
Diagnostic Performance of Initial Transperineal Template-guided Mapping Biopsy of the Prostate Gland
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DOI：
10.1097/coc.0b013e31829a2954
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发表时间：
2015-06-01
影响因子：
2.6
通讯作者：
Adamovich, Edward
中科院分区：
文献类型：
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作者：
Bittner, Nathan;Merrick, Gregory S.;Adamovich, Edward
目的：评价经会阴模板引导前列腺穿刺活检（TTMB）作为建立组织诊断的初始手段的效用。材料和方法：共有191例连续患者采用基于解剖的技术对24个区域进行前列腺TTMB取样。所有患者在常规筛查中前列腺特异性抗原升高，随后进行确诊性前列腺特异性抗原检查，没有人接受过前列腺活检。记录每位患者的癌症发生部位，以估计在标准的12核活检中遗漏癌症或低估Gleason评分的男性比例。提交活检针数的中位数为54.0。结果：191例研究患者中，140例（73.3%）经TTMB诊断为癌症。在这些活检阳性的患者中，124例（88.6%）有临床显著的癌症。活检阳性患者中89例（64.6%）Gleason评分为bb0 = 7。140例诊断出的癌症中，有34例完全在理论12核活检方案之外的区域被发现，这表明在没有TTMB的情况下，24.3%的这些癌症将未被诊断出来。在使用12核活检方法诊断的107例癌症中，18例（16.8%）通过定位活检升级到Gleason评分>= 7。结论：与标准的12芯活检方案相比，TTMB似乎提供了更多关于前列腺癌分级和位置的详细信息。这些信息可以作为图像引导活检（即磁共振成像）方案的基线参考，可以促进临床决策，并有助于适当选择患者进行主动监测。
Objectives: To evaluate the utility of transperineal template-guided mapping biopsy (TTMB) of the prostate as an initial means of establishing tissue diagnosis.Materials and Methods: A total of 191 consecutive patients underwent TTMB of the prostate using an anatomic-based technique with sampling of 24 regions. All patients had elevated prostate-specific antigen on routine screening which was followed by a confirmatory prostate-specific antigen and none had undergone previous biopsy of the prostate. The locations of cancer involvement were recorded for each patient in an effort to approximate the percentage of men whose cancer would have been missed or Gleason score underestimated on a standard 12-core biopsy. The median number of submitted biopsy cores was 54.0.Results: Of the 191 study patients, 140 (73.3%) were diagnosed with cancer on TTMB. Among these biopsy-positive patients, 124 (88.6%) had clinically significant cancer. Eighty-nine of the biopsy-positive patients (64.6%) had a Gleason score of >= 7. A total of 34 of the 140 diagnosed cancers were identified exclusively in regions that fell outside of the theoretical 12-core biopsy scheme, suggesting that 24.3% of these cancers would have gone undiagnosed in the absence of TTMB. Among the 107 cancers that would have been diagnosed using a 12-core biopsy approach, 18 (16.8%) were upgraded to a Gleason score of >= 7 with mapping biopsy.Conclusions: TTMB appears to provide more detailed information about prostate cancer grade and location compared with standard 12-core biopsy scheme. This information may serve as a baseline reference for image-guided biopsy (ie, magnetic resonance imaging) regimens, may facilitate clinical decision making and aid in the appropriate selection of patients for active surveillance.