結合經會陰融合切片與模板導引切片診斷攝護腺癌

胡蔚祥、呂謹亨、林益聖、翁瑋駿、黃立華、陳祥來、許兆畬、童敏哲、歐宴泉

童綜合醫院 外科部 泌尿科

Combination of trans-perineal MRI– ultrasound fusion and template-guided mapping biopsy for Prostate Cancer Diagnosis

Wei-Shiang Hu, Chin-Heng Lu, Yi-Sheng Lin, Wei-Chun Weng, Li-Hua Huang,

 Hsiang-Lai Chen, Jow-Yu Hsu, Min-Che Tung, Yen-Chuan Ou

Division of Urology, Department of Surgery,

Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan

Purpose: Combination of trans-perineal MRI– ultrasound (MRI-US) fusion and template-guided mapping biopsy is a new method of prostate cancer diagnosis. We aimed to investigate the accuracy of this technique in our hospital.

Materials and Methods: Men with Prostate Imaging Reporting and Data System (PI-RADS) score 3 or higher prostate lesions in 3T MRI image underwent both trans-perineal 6-core MRI-US fusion and 12-core template-guided mapping biopsy between September, 2019 and August 2020 were enrolled. The primary outcome was cancer detection rate which defined as cancers of the International Society of Urologic Pathologists (ISUP) grade group 2 or higher. We recorded the grade group from biopsy to surgical specimens among those who underwent subsequent robot-assisted radical prostatectomy. Secondary outcomes were cancer detection rate stratified by PIRADS scores, digital rectal examination (DRE) findings, and grade reclassification between biopsy and radical prostatectomy.

Results: A total of 30 men underwent both biopsy methods. The mean PSA level was 7.96 ng/dL. 13(43.3%) of them had positive findings in DRE. The majority (56.6%) of men were recorded as PIRADS score 4. Cancer detection rate on combined biopsy was 23.3% whereas detection rates on trans-perineal MRI-US fusion and template-guided mapping biopsy alone were 16.6% and 20%. Cancer detection rates were 14.2%, 23.5%, 33.3% in those who were recorded as PIRADS score 3, 4 and 5. The cancer detection rate was significantly higher in men who had positive DRE findings than those who had negative findings (46.1% vs. 5.8%, p<0.05). 2 (28.5%) patients revealed upgrading from lower biopsy pathological result to higher surgical specimens Gleason score.

Conclusions: Prostate cancer detection rate was 23.3% in our study with the method of the combination of trans-perineal MRI-US fusion and template-guided mapping biopsy. The detection rate is improved by combining both techniques and in higher PIRADS score patients. Positive DRE findings may indicate higher detection rate. After radical prostatectomy, 2 patients revealed upgrading on histopathological results.