Multiparametric MRI guidance in first-time prostate biopsies: what is the real benefit?
Multiparametric MRI guidance in first-time prostate biopsies: what is the real benefit?
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DOI：
10.5152/dir.2015.46014
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发表时间：
2015-07-01
影响因子：
2.1
通讯作者：
Rozanes, Izzet
中科院分区：
文献类型：
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作者：
Acar, Omer;Esen, Tarik;Rozanes, Izzet
目的：随着前列腺多参数磁共振成像（MRI）功能的不断提高，人们正在尝试将MRI纳入常规前列腺活检。在这项研究中，我们旨在分析通过认知融合、经直肠超声（TRUS）引导和mri引导下的活检，对前列腺癌筛查阳性的初次活检患者的诊断结果。方法回顾性分析mp-MRI应用于常规临床后经直肠前列腺活检的140例患者。排除既往活检阴性（n=24）和直肠指检可疑为>= cT3前列腺癌（n=16）的患者。mp-MRI包括t2加权成像、弥散加权成像和动态对比增强成像。在检查mp-MRI数据后进行认知融合活检，而trus引导下的活检在MRI信息下盲法进行。在MRI引导下，采用实时靶向的方法进行腔内活检。结果2012年1月至2014年2月期间，共有100例符合纳入标准的患者接受了trus引导（n=37）、认知融合（n=49）和穿刺活检（n=14）。研究组的平均年龄、血清前列腺特异性抗原水平和前列腺大小没有显著差异。超声引导下活检组诊断前列腺癌的比例为51.3%，而认知融合组和穿刺活检组诊断前列腺癌的比例分别为55.1%和71.4% （P = 0.429）。trus引导组、认知融合组和穿刺活检组的前列腺癌临床检出率分别为69.1%、70.3%和90% （P = 0.31）。根据前列腺切除术标本的组织病理学变量，trus引导组、认知融合组和穿刺活检组明显前列腺癌的检出率分别为85.7%、93.3%和100%。结论在第一组经直肠前列腺活检中，mp-MRI指导并没有显著提高诊断率。
PURPOSEWith the increased recognition of the capabilities of prostate multiparametric (mp) magnetic resonance imaging (MRI), attempts are being made to incorporate MRI into routine prostate biopsies. In this study, we aimed to analyze the diagnostic yield via cognitive fusion, transrectal ultrasound (TRUS)-guided, and in-bore MRI-guided biopsies in biopsy-naive patients with positive findings for prostate cancer screening.METHODSCharts of 140 patients, who underwent transrectal prostate biopsy after the adaptation of mp-MRI into our routine clinical practice, were reviewed retrospectively. Patients with previous negative biopsies (n=24) and digital rectal examination findings suspicious for >= cT3 prostate cancer (n=16) were excluded. T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging were included in mp-MRI. Cognitive fusion biopsies were performed after a review of mp-MRI data, whereas TRUS-guided biopsies were performed blinded to MRI information. In-bore biopsies were conducted by means of real-time targeting under MRI guidance.RESULTSBetween January 2012 and February 2014, a total of 100 patients fulfilling the inclusion criteria underwent TRUS-guided (n=37), cognitive fusion (n=49), and in-bore (n=14) biopsies. Mean age, serum prostate specific antigen level, and prostate size did not differ significantly among the study groups. In TRUS-guided biopsy group, 51.3% were diagnosed with prostate cancer, while the same ratio was 55.1% and 71.4% in cognitive fusion and in-bore biopsy groups, respectively (P = 0.429). Clinically significant prostate cancer detection rate was 69.1%, 70.3%, and 90% in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively (P = 0.31). According to histopathologic variables in the prostatectomy specimen, significant prostate cancer was detected in 85.7%, 93.3%, and 100% of patients in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively.CONCLUSIONIn the first set of transrectal prostate biopsies, mp-MRI guidance did not increase the diagnostic yield significantly.