最佳化核磁共振超音波融合經會陰攝護腺切片:飽和標靶切片

張天佑¹，林維卿²，張菡³，黃志平¹、張兆祥¹、吳錫金¹、楊啟瑞¹、陳國樑¹、陳汶吉¹、張議徽¹、謝博帆¹

¹中國附醫泌尿部、²中國附醫醫學影像部、³中國附醫病理部

Optimizing the biopsy strategy of MRI/US fusion transperineal prostate biopsy: saturation target biopsy

Tian-You Chang¹/ Wei-Ching Lin²/Han Chang³/ Chi-Ping Huang¹ / Chao-Hsiang Chang¹/Hsi-Chin Wu¹ /Chi-Rei Yang¹ / Kuo-Liang Chen¹/Wen-Chi Chen¹ / Yi-Huei Chang¹ /Po-Fan Hsieh¹

¹Department of Urology, China Medical University Hospital, Taichung, Taiwan

²Department of Radiology, China Medical University Hospital, Taichung, Taiwan

³Department of Pathology, China Medical University Hospital, Taichung, Taiwan

Introduction:

Magnetic resonance (MR)/ultrasonography (US) fusion-guided prostate biopsy can increase detection rate of clinically significant prostate cancer compared with random biopsy, and how to overcome the learning curve is an important issue. We compared the cancer detection rates of different transperineal biopsy templates to determine the best biopsy strategy for the beginning stage of MR/US fusion-guided prostate biopsy.

Materials and Methods:

We collected 49 men undergoing transperineal MR/US fusion-guided biopsy between 2019 and 2020. The prostate multiparametric MRI were reported according to the Prostate Imaging Reporting and Data System (PI-RADS) v2.1, and up to 3 targets were identified on each MRI. All men underwent targeted biopsy (TB) for targets with PI-RADS score 3-5, followed by systematic biopsy (SB) using the Ginsburg protocol. We compared the detection rates for overall and Gleason score ≥7 prostate cancer by TB, saturation TB (sTB) including cores from sectors adjacent to the target, and combining TB with SB.

Results

In total 56 targets with PI-RADS ≥3 were identified in 39 men. Cancer was detected in 23 men and Gleason score 7–10 cancer in 20 men. Overall cancer detection rate was 44%, 56% and 59% for TB alone, sTB and TB+SB. GS≧7 prostate cancer detection rate was 38%, 49% and 51% for TB alone, sTB and TB+SB. Mcnemar analysis revealed statistically significant difference between detection rates of TB and TB+SB. There was no significant difference of detection rates between sTB and TB+SB.  

Conclusion

sTB detected 11% more Gleason score 7–10 cancer than TB alone approach, and detect 95% of cancer detected by TB+SB. Therefore, sTB could overcome mistargeting during TB or misreading of MRI in the beginning stage of MR/US fusion-guided prostate biopsy.