Operator is an Independent Predictor of Detecting Prostate Cancer at Transrectal Ultrasound Guided Prostate Biopsy
Operator is an Independent Predictor of Detecting Prostate Cancer at Transrectal Ultrasound Guided Prostate Biopsy
复制标题
DOI：
10.1016/j.juro.2009.08.036
复制
发表时间：
2009-12-01
影响因子：
6.6
通讯作者：
Fleshner, Neil E.
中科院分区：
文献类型：
--
作者：
Lawrentschuk, Nathan;Toi, Ants;Fleshner, Neil E.
目的：我们研究了在经直肠超声引导前列腺活检检测前列腺癌的设置中是否存在手术操作者差异。我们的第二个目的是调查是否存在学习曲线的前列腺癌detect.Materials和方法：前瞻性数据库，从2000年至2008年，包括9,072经直肠超声引导前列腺活检在我们的机构仅限于4,724在最初的介绍。由4名泌尿放射科医生进行活检。计算了经直肠超声引导前列腺活检检测癌症的OR，可能是独立的预后变量，包括操作者。我们还检查了活检阳性率的增量，比较第一和最后一个队列。活检次数最多（75%）的高级放射科医生（AT）被认为是前列腺癌检测的参考。单变量和多变量logistic回归模型用于确定显著的协变量，p < 0.05被认为是相关的。结果：在2,331名男性（49.3%）中检测到前列腺癌。术者进行了514例经直肠超声引导前列腺活检（范围187 - 3，509），前列腺癌检出率为43.8%-52.4%（p = 0.001）。其他显著的协变量为前列腺特异性抗原、超声检查可疑病变、直肠指诊结节、前列腺体积缩小和患者年龄增加。术者是癌症检测的显著多变量预测因子（OR 0.67至0.89，p = 0.003）。没有学习曲线检测和活检率是一致的整个series.Conclusions：前列腺癌检测存在显着差异之间的操作者进行经直肠超声引导下前列腺活检，即使在相同的设置。先前进行的经直肠超声引导前列腺活检的体积似乎不会影响前列腺癌的阳性检出率，也无法确定学习曲线。操作员之间前列腺癌检测的差异可能与专业知识或技术的未知差异有关。需要进一步研究。
Purpose: We investigated whether interoperator differences exist in the setting of prostate cancer detection by transrectal ultrasound guided prostate biopsy. Our secondary aim was to investigate whether a learning curve exists for prostate cancer detection.Materials and Methods: A prospective database from 2000 to 2008 including 9,072 transrectal ultrasound guided prostate biopsies at our institution was limited to 4,724 done at initial presentation. Biopsies were performed by 4 uroradiologists. The OR for detecting cancer on transrectal ultrasound guided prostate biopsy was calculated for likely independent prognostic variables, including operator. We also examined the rate of biopsy positivity in increments, comparing the first and last cohorts. The senior radiologist (AT) with the most biopsies (75%) was considered the referent for prostate cancer detection. Univariate and multivariate logistic regression modeling was used to determine significant covariates with p < 0.05 deemed relevant.Results: Prostate cancer was detected in 2,331 men (49.3%). Operators performed a median of 514 transrectal ultrasound guided prostate biopsies (range 187 to 3,509) with a prostate cancer detection rate of 43.8% to 52.4% (p = 0.001). Other significant covariates were prostate specific antigen, suspicious lesions on ultrasound, nodule on digital rectal examination, smaller prostate volume and increasing patient age. Operator was a significant multivariate predictor of cancer detection (OR 0.67 to 0.89, p = 0.003). No learning curve was detected and biopsy rates were consistent throughout the series.Conclusions: Significant differences in prostate cancer detection exist among operators who perform transrectal ultrasound guided prostate biopsy even in the same setting. The volume of previously performed transrectal ultrasound guided prostate biopsies does not appear to influence the positive prostate cancer detection rate, nor could a learning curve be identified. Differences in prostate cancer detection among operators are likely related to unknown differences in expertise or technique. Further research is needed.