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针对MRI的前列腺融合活检:我们在目标之外错过了什么? 对治疗规划的影响
Marco Oderda1, Alessandro Dematteis1, Giorgio Calleris1
1Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, 10126 Torino, Italy.
在磁共振成像 (MRI) 向活检 (TBx) 后的系统活检 (SBx) 检测出单独的TBx遗漏的显著前列腺癌 (PCa). 结合两种活检方法可以改善PCa检测,特别是临床上显著的PCa.
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.
- 诊断成像 诊断成像 诊断成像
背景情况:
- 磁共振成像 (MRI) 向活检 (TBx) 越来越多地用于前列腺癌 (PCa) 检测.
- 在TBx之后,系统活检 (SBx) 的诊断产量仍然是一个研究领域.
- 了解MRI目标之外的PCa检测率对于优化活检策略至关重要.
研究的目的:
- 在多中心融合活检设置中评估TBx后SBx的诊断附加值.
- 评估在MRI目标之外检测到的前列腺癌的患病率和预测因素.
- 为了确定SBx阴性或TBx阴性病例中发现的PCa的意义.
主要方法:
- 从962名接受融合活检的患者收集数据 (2022-2024年).
- 将前列腺癌分类为具有临床意义 (csPCa) 的等级≥2.
- 统计分析包括中位数测试,奇平方测试和用于预测因子识别的后勤回归.
主要成果:
- 在56%/50%的病例中,TBx检测到PCa/csPCa,而SBx在55%/45%的病例中检测到PCa/csPCa.
- 显著的PCa被诊断为10%的TBx和9%的SBx,而其他方法是负面的.
- 在33% (相同叶片) 和32% (对侧叶片) 中发现了MRI目标之外的瘤,通常是csPCa.
结论:
- 无论是TBx还是SBx都发现了相当大比例的csPCa,而另一种模式是负的.
- 建议在TBx之后使用SBx,以最大限度地降低缺失csPCa焦点的风险.
- 阳性数字直肠检查 (DRE),PSA密度≥0.15,PI-RADS得分5是MRI目标之外的逆侧PCa的预测指标.
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