- 作者：M. Minhaj Siddiqui ; Soroush Rais-Bahrami ; Hong Truong ; Lambros Stamatakis ; Srinivas Vourganti ; Jeffrey Nix ; Anthony N. Hoang ; Annerleim Walton-Diaz ; Brian Shuch ; Michael Weintraub ; Jochen Kruecker ; Hayet Amalou ; Baris Turkbey ; Maria J. Merino ; Peter L. Choyke ; Bradford J. Wood ; Peter A. Pinto
- 关键词：Image-guided biopsy ; Targeted biopsy ; Magnetic resonance imaging ; Prostate cancer ; Prostatic neoplasms/diagnosis ; Prostatic neoplasms/pathology ; Prostatic neoplasms/ultrasonography
- 刊名：European Urology
- 出版年：2013
- 出版时间：November, 2013
- 年：2013
- 卷：64
- 期：5
- 页码：713-719
- 全文大小：1450 K
Background
Gleason scores from standard, 12-core prostate biopsies are upgraded historically in 25?33 % of patients. Multiparametric prostate magnetic resonance imaging (MP-MRI) with ultrasound (US)-targeted fusion biopsy may better sample the true gland pathology.Objective
The rate of Gleason score upgrading from an MRI/US-fusion-guided prostate-biopsy platform is compared with a standard 12-core biopsy regimen alone.
Design, setting, and participants
There were 582 subjects enrolled from August 2007 through August 2012 in a prospective trial comparing systematic, extended 12-core transrectal ultrasound biopsies to targeted MRI/US-fusion-guided prostate biopsies performed during the same biopsy session.
Outcome measurements and statistical analysis
The highest Gleason score from each biopsy method was compared.
Interventions
An MRI/US-fusion-guided platform with electromagnetic tracking was used for the performance of the fusion-guided biopsies.
Results and limitations
A diagnosis of prostate cancer (PCa) was made in 315 (54 % ) of the patients. Addition of targeted biopsy led to Gleason upgrading in 81 (32 % ) cases. Targeted biopsy detected 67 % more Gleason ¡Ý4 + 3 tumors than 12-core biopsy alone and missed 36 % of Gleason ¡Ü3 + 4 tumors, thus mitigating the detection of lower-grade disease. Conversely, 12-core biopsy led to upgrading in 67 (26 % ) cases over targeted biopsy alone but only detected 8 % more Gleason ¡Ý4 + 3 tumors. On multivariate analysis, MP-MRI suspicion was associated with Gleason score upgrading in the targeted lesions (p < 0.001). The main limitation of this study was that definitive pathology from radical prostatectomy was not available.
Conclusions
MRI/US-fusion-guided biopsy upgrades and detects PCa of higher Gleason score in 32 % of patients compared with traditional 12-core biopsy alone. Targeted biopsy technique preferentially detects higher-grade PCa while missing lower-grade tumors.