經會陰軟體輔助核磁共振超音波影像融合前列腺切片與經會陰認知融合切片之比較研究

鐘伯恩¹、羅啟文^1,2、張嘉論¹、周奕儒¹、曾聖修¹、蔡秉軒¹、蔡曜州^1,2

佛教慈濟醫療財團法人台北慈濟醫院 泌尿科; 慈濟大學 醫學系

Comparison of Transperineal Software-Assisted Fusion Prostate Biopsy and Transperineal Cognitive Fusion Prostate Biopsy

Bor-En Jong¹, Chi-Wen Lo¹, Chia-Lon Chang¹, Yi-Ru Chou¹, Shen-Shou Tseng¹, Bin-Shang Tsai¹,

Yao-Chou Tsai^1,2

Division of Urology, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan

Purpose:

This study compares the effectiveness of Transperineal Software-Assisted Fusion Biopsy (TSAFB) and Transperineal Cognitive Fusion Biopsy (TCFB) in diagnosing prostate cancer, focusing on the detection of clinically significant cancer.

Materials and Methods:

Conducted from December 2022 to December 2023 at a single center, this retrospective cohort study included male patients aged 40 and above with PSA levels >4 ng/ml or positive DRE findings, and suspicious lesions on mpMRI (PI-RADS ≥3). Exclusions were prior prostate treatments, bleeding disorders, active infections, or anesthesia contraindications. The study compared TSAFB using the KOELIS Trinity® MRI TPUS Biopsy System with TCFB. Primary outcomes were the detection rates of clinically significant prostate cancer and clinically insignificant prostate cancer. Data were collected retrospectively from electronic medical records, including demographics, biopsy, imaging findings, and pathology outcomes. 

Results:

In this retrospective cohort study comparing software-assisted and cognitive fusion biopsy techniques in prostate cancer diagnostics, data from two cohorts totaling 48 individuals (31 in software-assisted and 17 in cognitive fusion) collected from December 1, 2022, to December 31, 2023, were analyzed. The study found no significant differences in baseline characteristics between the two groups, indicating a comparable demographic and clinical profile. Notably, the study underscored that omitting systematic biopsies in the software-assisted fusion approach did not compromise cancer detection efficacy. In contrast, a targeted-only biopsy strategy using cognitive fusion resulted in nearly 20% of cancers remaining undetected. Specifically, in cases where only Target 1 (the main target) biopsies were performed, the software-assisted method failed to detect cancer in just one instance, highlighting its robustness in cancer detection across varied biopsy strategies.

Conclusion:

The study demonstrates that TSAFB and TCFB techniques have comparable detection rates for clinically significant prostate cancer, highlighting their efficacy in diagnosis. However, the omission of systematic biopsy in TCFB approaches risks missing approximately 20% of cases, underscoring the importance of incorporating systematic approaches to ensure comprehensive cancer detection.