Changes in prostate cancer detection rate of MRI-TRUS fusion vs systematic biopsy over time: evidence of a learning curve
Changes in prostate cancer detection rate of MRI-TRUS fusion vs systematic biopsy over time: evidence of a learning curve
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DOI：
10.1038/pcan.2017.34
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发表时间：
2017-12-01
影响因子：
4.8
通讯作者：
Pinto, P.
中科院分区：
文献类型：
--
作者：
Calio, B.;Sidana, A.;Pinto, P.
背景技术背景：在NCI 9年多参数磁共振成像（mpMRI）/TRUS融合活检的经验中，确定泌尿科医生和放射科医生学习曲线的影响以及MRI-TRUS融合平台的变化。方法：回顾了2007年至2016年接受mpMRI后进行融合活检（Fbx）和系统活检（Sbx）的患者的前瞻性维护数据库。根据首次活检的时间对患者进行分层。队列1（7/2007 - 12/2010）解释了学习曲线。队列2（1/2011-5/2013）和队列3（5/2013-4/2016）分别包括在新软件平台首次使用之前和之后进行活检的患者。临床显著（CS）疾病定义为Gleason 7（3+4）或更高。McNemar检验比较了Sbx和Fbx在不同时间段的癌症检出率（CDR）。结果：1528例患者被纳入本研究，其中230例、537例和761例患者分别被纳入三个队列。三个队列的中位年龄（四分位距）分别为61.0（+/- 9.0）、62.0（+/- 7.3）和64.0（+/- 11.0）岁（P < 0.001）。队列1中Fbx和Sbx的CS CDR相当（24.8 vs 22.2%，P = 0.377）。在接下来的两个时期，与Sbx相比，FBx检测到了更多的CS疾病（队列2：31.5% vs 25.0%，P = 0.001;队列3：36.4% vs 30.3%，P < 0.001），并且在同一时期检测到的低风险疾病显著较少（队列2：14.5 vs 19.6%，P < 0.001;队列3：12.6 vs 16.7%，P < 0.001）。即使在对年龄、PSA、种族、临床分期和MRI怀疑评分进行多变量调整后，Fbx CS癌症检测在连续队列中也增加（队列2：OR 2.23，P = 0.043;队列3：OR 2.92，P = 0.007）。我们的研究结果表明，在早期学习期后，与Sbx相比，Fbx检测到CS癌症的发病率较高，而临床无意义癌症的发病率较低。软件的进步允许更大的检测CS疾病。
BACKGROUND: To determine the effect of urologist and radiologist learning curves and changes in MRI-TRUS fusion platform during 9 years of NCI's experience with multiparametric magnetic resonance imaging (mpMRI)/TRUS fusion biopsy.METHODS: A prospectively maintained database of patients undergoing mpMRI followed by fusion biopsy (Fbx) and systematic biopsy (Sbx) from 2007 to 2016 was reviewed. The patients were stratified based on the timing of first biopsy. Cohort 1 (7/2007 - 12/2010) accounted for learning curve. Cohort 2 (1/2011-5/2013) and cohort 3 (5/2013-4/2016) included patients biopsied prior to and after debut of a new software platform, respectively. Clinically significant (CS) disease was defined as Gleason 7 (3+4) or higher. McNemar's test compared cancer detection rates (CDRs) of Sbx and Fbx between time periods.RESULTS: 1528 patients were included in the study with 230, 537 and 761 patients included in three respective cohorts. Median age (interquartile range) was 61.0 (+/- 9.0), 62.0 (+/- 7.3), and 64.0 (+/- 11.0) years in three cohorts, respectively (P < 0.001). Fbx and Sbx had comparable CS CDR in cohort 1 (24.8 vs 22.2%, P = 0.377). Fbx detected significantly more CS disease compared to Sbx in the following two periods (cohort 2: 31.5 vs 25.0%, P = 0.001; cohort 3: 36.4 vs 30.3%, P < 0.001) and detected significantly less low risk disease in the same period (cohort 2: 14.5 vs 19.6%, P < 0.001; cohort 3: 12.6 vs 16.7%, P < 0.001). Even after multivariate adjustment with age, PSA, race, clinical stage and MRI suspicion score, Fbx CS cancer detection increased in successive cohorts (cohort 2: OR 2.23, P = 0.043; cohort 3: OR 2.92, P = 0.007).CONCLUSIONS: In the past 9 years, there has been significant improvement in the accuracy of Fbx. Our results show that after an early learning period, Fbx detected higher rates of CS cancer and lower rates of clinically insignificant cancer than Sbx. Software advances allowed for even greater detection of CS disease.