Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen.
Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen.
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DOI：
10.1016/j.eururo.2013.03.025
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发表时间：
2014-04
期刊：
影响因子：
23.4
通讯作者：
Marks, Leonard S.
中科院分区：
文献类型：
--
作者：
Sonn, Geoffrey A.;Chang, Edward;Natarajan, Shyam;Margolis, Daniel J.;Macairan, Malu;Lieu, Patricia;Huang, Jiaoti;Dorey, Frederick J.;Reiter, Robert E.;Marks, Leonard S.
常规活检无法检测出某些前列腺癌（PCas）的存在。前列腺特异性抗原（PSA）持续升高但活检结果为阴性的男性患者在诊断上面临两难境地，因为有些人患有难以捉摸的癌症。确定与重复常规活检相比，使用磁共振-超声（MR-US）融合活检是否能提高PCa的检出率。在一项传唤病例系列研究中，105例既往活检阴性且PSA值升高的受试者在门诊接受了多参数磁共振成像（MRI）和融合活检。由放射科医生对多参数MRI上的可疑区域进行描绘和分级;由泌尿科医生使用Artemis器械进行MR-US融合活检;无论MRI结果如何，均获得靶向和系统性活检。确定所有PCa和临床显著PCa（Gleason ≥3 + 4或Gleason 6，最大癌核长度≥4 mm）的检出率。将靶向活检的产率与系统性活检进行比较。研究了MRI分级系统预测临床显著癌症的能力。进行逐步多变量逻辑回归分析以确定活检中显著癌症的预测因子。融合活检显示105名男性中有36名患有PCa（34%; 95%置信区间[CI]，25-45）。72%的PCa男性患有临床显著疾病; 23名PCa男性中有21名（91%）在靶向活检中患有显著癌症，而28名男性中有15名（54%）患有系统性活检。在多变量分析中，MRI的怀疑程度是显著癌症的最有力预测因素。14例高度可疑MRI靶点的受试者中有12例（86%）被诊断为具有临床意义的癌症。MR-US融合活检可改善既往活检阴性和PSA值升高的男性中PCa的检测。发现的大多数癌症具有临床意义。
Conventional biopsy fails to detect the presence of some prostate cancers (PCas). Men with a prior negative biopsy but persistently elevated prostate-specific antigen (PSA) pose a diagnostic dilemma, as some harbor elusive cancer. To determine whether use of magnetic resonance–ultrasound (MR-US) fusion biopsy results in improved detection of PCa compared to repeat conventional biopsy. In a consecutive-case series, 105 subjects with prior negative biopsy and elevated PSA values underwent multiparametric magnetic resonance imaging (MRI) and fusion biopsy in an outpatient setting. Suspicious areas on multiparametric MRI were delineated and graded by a radiologist; MR–US fusion biopsy was performed by a urologist using the Artemis device; targeted and systematic biopsies were obtained regardless of MRI result. Detection rates of all PCa and clinically significant PCa (Gleason ≥3 + 4 or Gleason 6 with maximal cancer core length ≥4 mm) were determined. The yield of targeted biopsy was compared to systematic biopsy. The ability of an MRI grading system to predict clinically significant cancer was investigated. Stepwise multivariate logistic regression analysis was performed to determine predictors of significant cancer on biopsy. Fusion biopsy revealed PCa in 36 of 105 men (34%; 95% confidence interval [CI], 25–45). Seventy-two percent of men with PCa had clinically significant disease; 21 of 23 men (91%) with PCa on targeted biopsy had significant cancer compared to 15 of 28 (54%) with systematic biopsy. Degree of suspicion on MRI was the most powerful predictor of significant cancer on multivariate analysis. Twelve of 14 (86%) subjects with a highly suspicious MRI target were diagnosed with clinically significant cancer. MR-US fusion biopsy provides improved detection of PCa in men with prior negative biopsies and elevated PSA values. Most cancers found were clinically significant.
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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：
6.6
作者：
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影响因子：
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影响因子：
6.6
作者：
Djavan, B;Ravery, V;Marberger, M
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影响因子：
2.1
作者：
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