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跨关节与跨直肠磁共振成像向前列腺活检:前性研究的系统审查和元分析
Fabio Zattoni1, Pawel Rajwa2, Marcin Miszczyk3
1Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy; Department of Medicine - DIMED, University of Padua, Padua, Italy.
European urology oncology
|August 2, 2024
概括
磁共振成像 (MRI) 向的跨膜 (TP) 前列腺活检和跨直肠 (TR) 前列腺活检显示了类似的前列腺癌检测率和并发症概况. TP活检提供了没有抗生素的安全替代方案,可能降低感染风险和抗生素耐药性.
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.
- 医疗成像医学成像
背景情况:
- 在临床上显著的前列腺癌 (csPCa) 检测中,MRI向的跨膜 (TP) 前列腺活检与跨直肠 (TR) 前列腺活检的比较疗效和安全性仍在调查中.
- 关于MRI引导前列腺活检的最佳方法的争论仍在继续,影响临床实践和患者的结果.
研究的目的:
- 系统地比较TP-Tbx和TR-Tbx程序之间的csPCa检测率和并发症概况.
- 评估MRI向前列腺活检技术的安全性和有效性.
主要方法:
- 在PubMed/Medline,Scopus和Web of Science进行了系统的文献搜索,寻找与TP-Tbx和TR-Tbx进行比较的潜在随机对照试验 (RCT).
- 评估的主要结果包括csPCa的检测率 (国际泌尿病学学会 (ISUP) ≥2) 和程序并发症率.
主要成果:
- 包括三个RCT (PREVENT,ProBE-PC,PERFECT),在TP-Tbx和TR-Tbx之间检测的csPCa (OR 0.9,95%CI:0.7-1.1) 或ISUP 1PCa (OR 1.1,95%CI:0.8-1.4) 中没有显著差异.
- 在两种方法之间,术后感染 (OR 0.8,95% CI:0.4-1.8),败血症 (OR 0.6,95% CI:0.1-4.5) 和尿路保留 (OR 0.5,95% CI:0.1-1.6) 的并发症率相似.
- 虽然TP-Tbx的疼痛最初更高,但在7天后差异最小化;TP-Tbx可以在没有抗生素的情况下安全进行,与TR-Tbx不同.
结论:
- TP-Tbx和TR-Tbx在检测前列腺癌和治疗活检相关的疼痛和并发症方面表现出相似的疗效.
- TP-Tbx允许在没有增加感染风险的情况下省略预防性抗生素,这比TR-Tbx具有潜在的优势.
- 尽管缺乏统计学意义,但与感染和败血症相关的结果表明TP方法的有利趋势,需要在临床实践中进一步考虑.
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