核磁共振與超音波融合影像攝護腺切片學習曲線-中醫附醫四年經驗探討

李柏毅、謝博帆、黃志平、張兆祥、吳錫金、張議徽

中國醫藥大學附設醫院 泌尿部

4-Year Experience in CMUH for

Learning Curve of MRI/Ultrasound Fusion-Guided Prostate Biopsy

Po-I Li , Po-Fan Hsieh , Chi-Ping Huang , Chao-Hsiang Chang , His-Chin Wu , Yi-Huei Chang

China Medical University Hospital, Taichung, Taiwan

Purpose :MRI/ultrasound fusion guided biopsy can detect more clinically significant prostate cancer(csPC) than conventional transrectal ultrasound-guided systematic biopsy. However, the learning curve for accuracy may limit the generalizability of this technique. We report the results of the learning curve of a single urologist in CMUH for cancer detection rates over a 4-year period.

Materials and Methods: We prospectively collected the patients who received MRI/US fusion guided biopsy from January 2019 to March 2022. All the procedure was performed by a single urologist using the Biojet fusion system with transperineal approach. Before 2021, all the biopsy was guided by a grid template. Since 2021, the procedure was done with free-hand biopsy without a grid template. We divided the cohort into four groups by year. We used One way ANOVA test to evaluate the temporary change of csPC detection rates and McNemar’s test to compare csPC detection rates between targeted biopsy and systematic biopsy. Furthermore, we compared the csPC detection rates stratified by PI-RADS score, csPC detection rates of anteriorly targeted lesion, csPC detection rates of targeted lesion ≤ 1cm and upper Gleason score upper grading rate after radical prostatectomy among each groups.

Results: 164 patients were collected including 41 , 43, 62 and 18 cases in 2019,2020,2021 and 2022 ,respectively. All patient characteristics including age , median PSA level, biopsy cores, status of previous negative biopsy and median PI-RADS score did not vary significantly between groups.

csPC detection rates increased significantly with time (P<0.05). Over the 4-year period, systematic biopsy detected more csPC than targeted biopsy initially. Targeted biopsy detection rate for csPC was increased significantly with time(P<0.05). Besides, in terms of PI-RADS≥ 4 lesion, anteriorly targeted lesion and targeted lesion ≤ 1cm , there was a trend that detection rates were all increased during the 4-year period. The upper grading rates of Gleason score was also tended to decrease with time.

Conclusion: The accuracy of MRI/ultrasound fusion guided biopsy can be improved with experience. Increased detection rate of anteriorly targeted lesion or targeted lesion ≤ 1cm might be related to use of transperineal free-hands biopsy. In addition, at the initial learning curve, systematic biopsy can play a complementary role for targeted biopsy.