Magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy using three‐dimensional ultrasound‐based organ‐tracking technology: Initial experience in Japan
Magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy using three‐dimensional ultrasound‐based organ‐tracking technology: Initial experience in Japan
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使用基于三维超声的器官跟踪技术进行磁共振成像/经直肠超声融合靶向前列腺活检：日本的初步经验
DOI：
10.1111/iju.13924
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发表时间：
2019
影响因子：
2.6
通讯作者：
Ukimura Osamu
中科院分区：
文献类型：
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作者：
Yamada Yasuhiro;Fujihara Atsuko;Shiraishi Takumi;Ueda Takashi;Yamada Takeshi;Ueno Akihisa;Inoue Yuta;Kaneko Masatomo;Kamoi Kazumi;Hongo Fumiya;Okihara Koji;Ukimura Osamu
目的评价磁共振成像/经直肠超声融合靶向前列腺活检在基于实时三维超声器官跟踪技术诊断具有临床意义的前列腺癌中的作用。方法回顾性分析262例前列腺特异性抗原为7.1 ng/mL（四分位数范围4.0 ~ 19.8）的连续患者。所有患者均接受活检前磁共振成像，并有可疑的临床显著前列腺癌病变。所有患者均接受了系统活检（6例）和基于三维超声的磁共振成像/经直肠超声融合靶向活检（2例）。比较系统活检与磁共振成像/经直肠超声融合靶向前列腺活检的任何癌症的阳性率、临床显著性前列腺癌的阳性率、Gleason评分和最大癌核长度。结果总体而言，每位患者在系统活检中任何癌症的阳性率为61%(160/262)，而在磁共振成像/经直肠超声融合靶向活检中为79% (207/262)(P< 0.0001)；系统活检中有临床意义的前列腺癌的比例为46%(120/262)，而磁共振成像/经直肠超声融合靶向活检中为70% (181/262)（P< 0.0001）。系统活检中每芯癌的阳性率为21.7%(33 /1523)，而磁共振成像/经直肠超声融合-靶向活检的阳性率为68.6% (406/592)(P< 0.0001)；系统活检中每芯临床显著性前列腺癌的阳性率为12.7%(193/1423)，而磁共振成像/经直肠超声融合-靶向活检的阳性率为60.3% (357/592)（P< 0.0001）。增加系统活检导致13例癌症病例增加（5%）。系统活检的Gleason评分（6/7/8/9/10）分布为59/71/23/6/1，而磁共振成像/经直肠超声融合靶活检的Gleason评分分布为48/105/36/15/2 （P= 0.005）。系统活检的最大癌芯长度为5 mm(0.5-16)，而磁共振成像/经直肠超声融合靶向活检的最大癌芯长度为8 mm (1-19 mm) （P< 0.0001）。结论基于三维超声的磁共振成像/经直肠超声融合靶向活检似乎与临床意义显著的前列腺癌的检出率更高，比系统随机活检的核数更少。然而，重大的癌症仍然只能通过系统技术来检测。系统活检与靶向活检技术的结合将避免临床意义重大的前列腺癌的漏诊。
ObjectiveTo evaluate the impact of magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy on the diagnosis of clinically significant prostate cancer using real‐time three‐dimensional ultrasound‐based organ‐tracking technology.MethodsThe present study was a retrospective review of 262 consecutive patients with prostate‐specific antigen of 7.1 ng/mL (interquartile range 4.0–19.8). All patients received pre‐biopsy magnetic resonance imaging and had a suspicious lesion for clinically significant prostate cancer. All patients underwent a combination of systematic biopsy (6 cores) and three‐dimensional ultrasound‐based magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (2 cores). The positive rate of any cancer, positive rate of clinically significant prostate cancer, Gleason score and maximum cancer core length were compared between systematic biopsy versus magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy.ResultsOverall, the positive rate of any cancer per patient was 61% (160/262) in systematic biopsy versus 79% (207/262) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P< 0.0001); and that of clinically significant prostate cancer per patient was 46% (120/262) in systematic biopsy versus 70% (181/262) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P< 0.0001). The positive rate of any cancer per core was 21.7% (330/1523) in systematic biopsy versus 68.6% (406/592) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P< 0.0001), and that of clinically significant prostate cancer per core was 12.7% (193/1423) in systematic biopsy versus 60.3% (357/592) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P< 0.0001). Adding systematic biopsy leads to 13 more cancer cases (5%). The distribution of Gleason score (6/7/8/9/10) was 59/71/23/6/1 in systematic biopsy versus 48/105/36/15/2 in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P= 0.005). The maximum cancer core length was 5 mm (0.5–16) in systematic biopsy versus 8 mm (1–19 mm) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P< 0.0001).ConclusionsThree‐dimensional ultrasound‐based magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy seems to be associated with a higher detection rate of clinically significant prostate cancer, with fewer cores than systematic random biopsy. However, significant cancer can still be detected by the systematic technique only. A combination of systematic biopsy with the targeted biopsy technique would avoid the underdiagnosis of clinically significant prostate cancer.
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