Prostate Magnetic Resonance Imaging and Magnetic Resonance Imaging Targeted Biopsy in Patients with a Prior Negative Biopsy: A Consensus Statement by AUA and SAR.
Prostate Magnetic Resonance Imaging and Magnetic Resonance Imaging Targeted Biopsy in Patients with a Prior Negative Biopsy: A Consensus Statement by AUA and SAR.
复制标题
DOI：
10.1016/j.juro.2016.06.079
复制
发表时间：
2016-12
期刊：
影响因子：
--
通讯作者：
Taneja SS
中科院分区：
文献类型：
--
作者：
Rosenkrantz AB;Verma S;Choyke P;Eberhardt SC;Eggener SE;Gaitonde K;Haider MA;Margolis DJ;Marks LS;Pinto P;Sonn GA;Taneja SS
在最初的阴性活检后，需要制定策略来改善患者对重复活检的选择以及重复活检的诊断率。作为AUA（美国泌尿学会）和SAR（腹部放射学会）前列腺癌疾病聚焦小组的合作倡议，一个由泌尿科医生和放射科医生组成的专家小组对前列腺磁共振成像和磁共振成像靶向活检在阴性活检患者中的作用进行了文献回顾，并形成了共识声明，总结在本综述中。该小组认识到，对于先前活检呈阴性的男性，存在许多选择。如果推荐活检，前列腺磁共振成像和随后的靶向核磁共振成像似乎比标准化的重复活检更能促进临床重要疾病的检测。因此，当可以获得高质量的前列腺磁共振成像时，对于任何既往活检呈阴性且临床持续怀疑前列腺癌的患者，以及正在评估是否可能再次活检的患者，都应强烈考虑进行活检。是否在这种情况下进行磁共振成像的决定还必须考虑任何其他生物标志物的结果和检查费用，以及高质量前列腺磁共振成像解释的可用性。如果进行了磁共振成像，应按照PI-RADS版本2 （v2）指南进行操作、解释和报告。报告的放射科医生和活检操作员需要经验，以获得最佳结果，并建议将前列腺磁共振成像整合到患者护理中，实施质量保证计划，以监测目标活检结果。接受PI-RADS评估类别为3 - 5的患者需要在图像引导下进行重复活检。虽然经直肠超声引导的磁共振成像融合或内腔磁共振成像靶向可能对更可靠的靶向有价值，特别是对于小病变或位于困难位置的病变，但在缺乏此类靶向技术的情况下，认知（视觉）靶向仍然是熟练人员的合理方法。从每个磁共振成像确定的靶中至少获得2个靶核。鉴于有大量研究表明通过磁共振成像靶核漏掉了一定比例的具有临床意义的癌症，必须根据具体情况决定是否也同时进行系统采样。然而，只有在质量保证工作验证了前列腺磁共振成像解释的性能并且结果与已发表的文献一致的情况下，才应该考虑单独进行靶向活检。对于磁共振成像阴性或低怀疑的患者（PI-RADS评估类别分别为1或2），其他辅助标志物（如PSA、PSAD、PSAV、PCA3、PHI、4K）可能对确定需要重复系统活检的患者有价值，尽管需要进一步的数据。如果根据磁共振成像结果推迟了重复活检，则建议继续进行临床和实验室随访，并应考虑将重复磁共振成像纳入诊断监测方案。
After an initial negative biopsy there is an ongoing need for strategies to improve patient selection for repeat biopsy as well as the diagnostic yield from repeat biopsies. As a collaborative initiative of the AUA (American Urological Association) and SAR (Society of Abdominal Radiology) Prostate Cancer Disease Focused Panel, an expert panel of urologists and radiologists conducted a literature review and formed consensus statements regarding the role of prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a negative biopsy, which are summarized in this review. The panel recognizes that many options exist for men with a previously negative biopsy. If a biopsy is recommended, prostate magnetic resonance imaging and subsequent magnetic resonance imaging targeted cores appear to facilitate the detection of clinically significant disease over standardized repeat biopsy. Thus, when high quality prostate magnetic resonance imaging is available, it should be strongly considered for any patient with a prior negative biopsy who has persistent clinical suspicion for prostate cancer and who is under evaluation for a possible repeat biopsy. The decision of whether to perform magnetic resonance imaging in this setting must also take into account the results of any other biomarkers and the cost of the examination, as well as the availability of high quality prostate magnetic resonance imaging interpretation. If magnetic resonance imaging is done, it should be performed, interpreted and reported in accordance with PI-RADS version 2 (v2) guidelines. Experience of the reporting radiologist and biopsy operator are required to achieve optimal results and practices integrating prostate magnetic resonance imaging into patient care are advised to implement quality assurance programs to monitor targeted biopsy results. Patients receiving a PI-RADS assessment category of 3 to 5 warrant repeat biopsy with image guided targeting. While transrectal ultrasound guided magnetic resonance imaging fusion or in-bore magnetic resonance imaging targeting may be valuable for more reliable targeting, especially for lesions that are small or in difficult locations, in the absence of such targeting technologies cognitive (visual) targeting remains a reasonable approach in skilled hands. At least 2 targeted cores should be obtained from each magnetic resonance imaging defined target. Given the number of studies showing a proportion of missed clinically significant cancers by magnetic resonance imaging targeted cores, a case specific decision must be made whether to also perform concurrent systematic sampling. However, performing solely targeted biopsy should only be considered once quality assurance efforts have validated the performance of prostate magnetic resonance imaging interpretations with results consistent with the published literature. In patients with negative or low suspicion magnetic resonance imaging (PI-RADS assessment category of 1 or 2, respectively), other ancillary markers (ie PSA, PSAD, PSAV, PCA3, PHI, 4K) may be of value in identifying patients warranting repeat systematic biopsy, although further data are needed on this topic. If a repeat biopsy is deferred on the basis of magnetic resonance imaging findings, then continued clinical and laboratory followup is advised and consideration should be given to incorporating repeat magnetic resonance imaging in this diagnostic surveillance regimen.
登录
查看更多内容
DOI：
10.1016/j.urolonc.2011.02.014
发表时间：
2011-05
期刊：
Urologic oncology
影响因子：
--
作者：
Natarajan S;Marks LS;Margolis DJ;Huang J;Macairan ML;Lieu P;Fenster A
通讯作者：
Fenster A
影响因子：
2.5
作者：
Marks L;Young S;Natarajan S
通讯作者：
Natarajan S
影响因子：
1.6
作者：
Kaufmann, Sascha;Kruck, Stephan;Schilling, David
通讯作者：
Schilling, David
影响因子：
6.2
作者：
Filson CP;Natarajan S;Margolis DJ;Huang J;Lieu P;Dorey FJ;Reiter RE;Marks LS
通讯作者：
Marks LS
影响因子：
6.6
作者：
Vourganti, Srinivas;Rastinehad, Ardeshir;Yerram, Nitin K.;Nix, Jeffrey;Volkin, Dmitry;Hoang, An;Turkbey, Baris;Gupta, Gopal N.;Kruecker, Jochen;Linehan, W. Marston;Choyke, Peter L.;Wood, Bradford J.;Pinto, Peter A.
通讯作者：
Pinto, Peter A.