The Role of Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Biopsy in Active Surveillance
The Role of Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Biopsy in Active Surveillance
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DOI：
10.1016/j.eururo.2016.05.021
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发表时间：
2017-02-01
期刊：
影响因子：
23.4
通讯作者：
Carter, H. Ballentine
中科院分区：
文献类型：
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作者：
Ma, Ting Martin;Tosoian, Jeffrey J.;Carter, H. Ballentine
背景：多参数磁共振成像(MpMRI)/超声融合活检(靶向活检或TB)与系统活检(SB)相比可能提高对高级别癌症的检测。目的：评估主动监测(AS)中的TB。设计、环境和参与者：我们回顾评估了103名接受监视活检的男性、54名接受验证性活检(CB)的男性和73名转诊为诊断性活检(DB)的男性中的SB(12核心部分)和TB。MpMRI上的感兴趣区(ROI)被赋予PI-RADS评分，如果评分为3，则将其作为目标。结果测量和统计分析：除多变量模型中，任何癌症都是结果外，TB和SB检测到Gleason评分(GS)=7是感兴趣的结果。结果和限制：在AS组、CB组和DB组中，两种活检方法中GS&>=7的男性分别为25例(24.3%)、12例(22.2%)和55例(75.3%)。SB+TB和SB在AS组中GS>；=7的发生率分别为24.3%和20.4%；CB组中SB+TB和SB分别为22.2%和16.7%(P=0.002)；在AS队列中，GS>；=7检测结核的灵敏度低于SB(p=0.006)(相对灵敏度比为0.33，95%可信区间为0.16-0.71)。PI-RADS评分较高(4vs3，优势比[OR]2.00，p=0.04；5vs3，OR4.74，p=0.02)、MRI估计的前列腺体积较低(OR1.20/10 cm(3)，p=0.01)、较大的ROI(OR1.04/mm，p=0.02)和右侧ROI(OR2.27，p=0.01)与发现结核病癌症有关。一个潜在的限制是，并不是所有接受活检的男性都经历了结核病，而且在SB之前，泌尿科医生对MRI结果并不是盲目的。结论：由于mpMRI对GS>；=7疾病的检测相对敏感度较低，对于AS患者，仍然需要进行SB。患者总结：本研究表明，对于参加前列腺癌主动监测计划的男性，仅靠图像引导的前列腺活检可能不能提供信息。(C)2016年欧洲泌尿外科协会。爱思唯尔出版公司版权所有。
Background: Multiparametric magnetic resonance imaging (mpMRI)/ ultrasound fusion biopsy (targeted biopsy or TB) may improve detection of high-grade cancers when compared to systematic biopsy (SB).Objective: To assess TB in active surveillance (AS).Design, setting, and participants: We retrospectively evaluated SB (12-core sector) and TB among 103 AS men undergoing surveillance biopsy, 54 men undergoing confirmatory biopsy (CB), and 73 men referred for diagnostic biopsy (DB; comparison group). Regions of interest (ROIs) onmpMRI were assigned a PI-RADS score and targeted if the score was >= 3.Outcome measurements and statistical analysis: Detection of Gleason score (GS) >= 7 by TB and SB was the outcome of interest, except in a multivariable model, for which any cancer was the outcome.Results and limitations: GS >= 7was detected by either biopsy method in 25 men (24.3%) in the AS group, 12 men (22.2%) in the CB group, and 55 men (75.3%) in the DB group. GS >= 7 was found in 24.3% by SB + TB versus 20.4% by SB in the AS group (p = 0.13); in 22.2% by SB + TB versus 16.7% by SB in the CB group (p = 0.25); and in 75.3% by SB + TB versus 58.9% by SB in the DB group (p = 0.002). The sensitivity for GS >= 7 detection was lower for TB than for SB (p = 0.006) in the AS cohort (relative sensitivity ratio 0.33, 95% confidence interval 0.16-0.71). Higher PI-RADS score (4 vs 3, odds ratio [OR] 2.00, p = 0.04; 5 vs 3, OR 4.74, p = 0.02), lower MRI-estimated prostate volume (OR 1.20 per 10-cm(3) lower volume, p = 0.01), larger ROI (OR 1.04 per mm, p = 0.02), and right-sided ROI (OR 2.27, p = 0.01) were associated with finding cancer on TB. A potential limitation is that not all men who presented for biopsy underwent TB and the urologist was not blinded to MRI results before SB.Conclusions: Owing to the low relative sensitivity of mpMRI for detection of GS >= 7 disease, SB still needs to be performed for men on AS.Patient summary: This study suggests that image-guided prostate biopsy alone may not be informative for men enrolled in an active surveillance program for prostate cancer. (C) 2016 European Association of Urology. Published by Elsevier B. V. All rights reserved.