核磁共振影像融合導引切片及攝護腺根除術標本在癌症分期一致率的分析

康庭碩、溫晨越、余家政、陳逸軒、林仁泰

高雄榮民總醫院 外科部 泌尿外科

The Analysis of Concordance Rates Between Cancer Stage of MR/US Fusion Prostate Biopsy and Radical Prostatectomy Specimen

Ting-Shuo Kang, Chen-Yueh Wen, Chia-Cheng Yu, I-Hsuan Alan Chen, Jen-Tai Lin

Divisions of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

Purpose:

Magnetic resonance/ultrasound (MR/US) fusion–targeted biopsy combined with systematic biopsy has been widely used for detecting prostate cancer nowadays. We further need to know MR/US fusion–targeted biopsy whether have more accurate prediction of the final Gleason score and oncologic outcomes after radical prostatectomy (RP). In this study, we aimed to identify the accuracy of Gleason score of MR/US fusion-targeted prostate biopsy compared to RP pathological specimen.

Materials and Methods:

We retrospectively reviewed the patients underwent MR/US fusion-targeted prostate biopsy from October 2019 to December 2021 in a single center. Patient with suspected prostate cancer detected by mpMRI (PIRADS v2.0) were enrolled. Regardless of previous TRUS biopsy, all patients received MR/US fusion-targeted biopsy combined with systemic biopsy. RP was all performed by a robotic approach. Downgrading was defined as the presence of an inferior cancer staging (NCCN Guidelines^® Version 2, 2019), and upgrading was defined as the presence of a superior cancer staging. Concordance was considered when both RP and biopsy Gleason score were identical.

Results:

A total of 204 men underwent 3 Tesla mpMRI and fusion biopsy consecutively. The general characteristics were listed in table 1. The fusion biopsy was used to obtain targeted cores from the region of interest (ROI) (mean 13 biopsies) followed by a systematic biopsy (mean 9.3 biopsies). The mean overall number of biopsies taken was 22.3. Among the 204 men, 140 (68.6%) patients underwent first biopsy whereas 64 (31.4%) underwent repeated biopsy. The overall cancer detection rate was 33.8%. The overall rate of cancer staging concordance between prostate biopsy and RP specimen was 42.6%, the upgrading rate was 29.6%, and the downgrading rate was 27.8%. Lower concordance rate between target biopsy cores and RP (36.2%) compared to systematic biopsy (46.5%). An increase in the upgrading rate was found by target biopsy cores (40.4%) compared to systematic biopsy cores (32.6%).

Conclusion:

For patients with suspicious lesion found in mpMRI, fusion-targeted biopsy combined systematic biopsy detected more prostate cancer. It could not only provide the high cancer staging accuracy but also upgrade the final pathology report especially by target biopsy method.