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我们是否需要在所有未经活检的患者身上进行MRI? 一个多中心队列分析

Philipp Krausewitz¹, Angelika Borkowetz², Gernot Ortner³

¹Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), University Hospital Bonn, Bonn, Germany. Philipp.krausewitz@ukbonn.de.

World journal of urology

|February 7, 2024

概括

对于怀疑患有前列腺癌的男性,联合活检方法提供了最高的诊断准确性. 然而,对于老年男性或患有特定PSA水平升高的人来说,单独进行系统活检可能就足够了,从而降低了成本和资源使用.

科学领域:

泌尿器科泌尿器科泌尿器科泌尿器科
在瘤学瘤学.
放射学放射学是一门学科.

背景情况:

建议在临床上显著的前列腺癌 (csPCA) 检测中使用MRI导向活检 (TB) 和系统活检 (SB) 的联合活检 (CB).
由于MRI的可访问性有限和高成本,阻碍了广泛的CB实施.
确定可以单独接受SB的患者子集对于成本有效的诊断至关重要.

研究的目的:

为了确定一小组的活检的男人怀疑csPCA谁可以接受SB没有增加低诊断的风险.
通过优化诊断途径来评估降低活检成本的可行性.

主要方法:

对2714名确诊前列腺癌 (PCA) 和疑似MRI的男性进行了多中心分析.
使用McNemar配对测试,比较SB,TB和CB之间的癌症检测率.
对每个活检方法的格里森评分升级和降级的评估.

主要成果:

CB检测到的cspca比tb和sb更多 (p < 0.001).
单次活检方法对50%以上的csPCA进行了错误分级.
在患有异常DRE,PSA>12.5ng/ml,PSAD>0.35ng/ml/cm3或年龄>75岁的患者中,SB和CB显示出类似的csPCA检测率.

结论:

对于大多数没有做过活检的男性来说,CB提供了最高的诊断确定性.
在精选的患者中 (DRE异常,高PSA/PSAD,晚年),单单SB就产生了类似的csPCA检测率.
在这些特定患者群体的资源有限环境中,可以考虑减少活检协议 (仅SB).

关键词:

活检方法活检方法临床上显著的前列腺癌.这就是为什么MRI是MRI.系统活检是系统活检.

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