核磁共振超音波影像融合攝護腺切片與飽和切片在攝護腺癌診斷中的互補角色：切片效能與解剖分佈之深度分析

謝佳駤¹、曾文歆^1,2、劉建良^1,3、黃冠華¹、邱文祥⁴

¹台南永康奇美醫院 外科部 泌尿科；²高雄國立中山大學 生物醫學研究所；³台南永康奇美醫院 外科部 泌尿腫瘤科；⁴台北新光吳火獅紀念醫院 泌尿科

Complementary Roles of MR-Fusion and Saturation Biopsies in Prostate Cancer Detection: An Analysis of Biopsy Efficiency and Anatomical Distribution

Chia-Chih Hsieh¹、Wen-Hsin Tseng^1,2、Chien-Liang Liu ^1,3、Steven K. Huang¹、Allen W.Chiu⁴

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

²Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan

³Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.

⁴Division of Urology, Department of Surgery, Shin-Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan

Purpose: To evaluate the clinical characteristics, biopsy efficiency, and spatial anatomical distribution of prostate cancer (PCa) detected by magnetic resonance-transrectal ultrasound (MR-TRUS) fusion biopsy compared to traditional saturation biopsy, with a focus on exclusively detected cases.

Materials and Methods: We retrospectively reviewed 55 patients underwent both MR-fusion and saturation prostate biopsies between January 2024 and November 2025 at our medical center. There were 29 patients diagnosed with PCa. Clinical characteristics, PI-RADS scores, Gleason scores, and anatomical locations (Apex, Midgland, Base, Peripheral/ Transition Zone) were analyzed. The cohorts were stratified into MR-fusion confirmed cases (n=26) and saturation confirmed cases (n=23). Further subgroup analysis was performed on cancers exclusively detected by a single modality (Fusion-only n=6, Saturation-only n=3) to identify diagnostic blind spots.

Results: Baseline characteristics, including age, initial PSA, prostate size, and median primary Gleason score, were comparable between the MR-fusion and saturation positive cohorts. MR-fusion biopsy demonstrated significantly superior biopsy efficiency, requiring fewer total cores (6.8 ± 2.6 vs. 21.4 ± 5.2, p < 0.001) while achieving a higher positive core yield (64.3% vs. 40.4%, p = 0.011) without compromising the core tumor percentage (31.9% vs. 30.5%, p = 0.802). In the exclusive detection analysis, MR-fusion uniquely identified 6 cases, which included smaller lesions (mean 14.2 mm) and Transition Zone tumors (33.3%, 2/6) typically missed by systematic approaches. Conversely, saturation biopsy exclusively detected 3 cases, predominantly located at the Apex (66.7%, 2/3), compensating for potential MR-TRUS registration errors caused by probe deformation.

Conclusion: MR-fusion biopsy offers outstanding diagnostic efficiency and effectively targets anterior Transition Zone lesions with fewer cores. However, saturation biopsy remains a vital safety net to capture apical lesions susceptible to image registration errors. A combined biopsy approach leverages their anatomical synergy to maximize the detection of clinically significant prostate cancer.