MRI-TRUS影像辨認融合導引攝護腺切片
是否具較佳之切片與手術後病理格里森分數一致性？
顧明軒1、魏子鈞1, 3、王信凱2、沈書慧2、林子平1, 3、黃逸修1, 3、鍾孝仁1, 3、郭俊逸1, 3、黃志賢1, 3、張延驊1, 3、林登龍1, 3、陳光國1, 3
臺北榮民總醫院 1泌尿部，2放射線部；3國立陽明大學 醫學院 泌尿學科 書田泌尿科學研究中心
Does cognitive MRI-TRUS fusion targeted prostate biopsy have better gleason score concordance between biopsy and prostatectomy?
Ming-Hsuan Ku1, Tzu- Chun Wei1,3, Tzu-Ping Lin1,3, Eric Yi-Hsiu Huang1,3,
Hsiao-Jen Chung1,3, Junne-Yih Kuo1,3, , Williams J.S. Huang 1, 3, Yen-Hua Chang1,3, Hsin-Kai Wang2 , Shu-Huei Shen2 , Alex T. L. Lin1,3, Kuang-Kuo Chen1,3
1 Department of Urology;2Department of Radiology, Taipei Veterans General Hospital, Taiwan
3 Department of Urology, School of Medicine, and Shu-Tien Urological Institute,
National Yang-Ming University, Taipei, Taiwan
Purpose:
Gleason score based on biopsy results can help urologists characterize patients with prostate cancer into different risk groups and make treatment plans accordingly. Better Gleason score concordance between biopsy and prostatectomy indicates more reliable biopsy results. We aim to evaluate whether cognitive MRI-TRUS fusion targeted prostate biopsy may have better concordance between biopsy and radical prostatectomy than repeat 12-cores systemic random biopsy in patients with prior negative prostate biopsy.
Materials and Methods:
We retrospectively reviewed our database from December, 2013 to August, 2016; total 27 patients were diagnosed with prostate cancer through cognitive MRI-TRUS fusion targeted prostate biopsy with prior negative systemic result. . The other 39 patients undergone at least one time of repeat systemic prostate biopsy were enrolled as contrast. All these patients then recieved radical prostatectomy. Gleason scores of biopsy and prostatectomy specimens were analyzed as well as clinical information and lab data. Student’s t test and chi-square were used for statistical significance.
Results:
The concordance rates of Gleason scores of biopsies and radical prostatectomy specimens were 42.3% in cognitive MRI-TRUS fusion targeted biopsy group and 33.3% in repeat systemic biopsy group (P = 0.360). The Gleason scores were upgraded in 50.0% of cases in cognitive MRI-TRUS fusion targeted biopsy group and 46.2% in repeat systemic biopsy group (p = 0.873). Downgrading was found in 7.7% and 20.5% of cases in cognitive MRI-TRUS fusion targeted and repeat systemic biopsy groups respectively (p= 0.180). The primary Gleason score was accurately predicted in 84.6% of cases by cognitive MRI-TRUS fusion targeted biopsy and 69.2% by repeat systemic biopsy (p = 0.137).
Conclusion:
Compared to repeat systemic 12-cores prostate biopsy, cognitive MRI-TRUS fusion targeted biopsy have no significant but numerical difference in achieving better Gleason score concordance, less overgrading or downgrading between biopsy and radical prostatectomy and may be considered as a more reliable diagnostic method than repeat systemic 12-cores prostate biopsy in patients with suspected prostate cancer and prior negative systemic prostate biopsy.