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在MRI融合前列腺活检时代,定制活检策略:系统性,有针对性或没有?
Fredrik Jäderling1,2, Martin Bergman3,4, Jan Chandra Engel5
1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. fredrik.jaderling@ki.se.
BMC urology
|August 7, 2024
概括
将系统活检添加到MRI向活检中可以改善前列腺癌的检测. 然而,这种综合方法可能会增加在MRI检测结果模两可的男性中检测微不足道的癌症.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 放射学 放射学是一门学科.
- 在瘤学瘤学.
背景情况:
- 前列腺癌 (PCa) 检测通常使用MRI,然后进行向活检 (TBx).
- 系统活检 (SBx) 与TBx (组合活检;CBx) 对于可疑的MRI发现的附加益处尚不清楚.
研究的目的:
- 评估结合活检 (TBx + SBx) 与单独使用TBx的诊断产量,以检测怀疑MRI结果的男性的前列腺癌.
主要方法:
- 一项前性多中心研究分析了429名怀疑MRI病变的男性的活检结果.
- 参与者接受了双参数MRI (PI-RADS v2) 和随后的活检 (如果PI-RADS ≥3),则TBx + SBx).
- 终点包括临床无意义的 (nsPCa) 和显著的 (csPCa) 前列腺癌检测.
主要成果:
- 综合策略检测到csPCa在更多的男人比单独的TBx (43.6%对39.2%,P<0.02).
- 对cspca的检测率随PI-RADS得分的增加而增加 (PI-RADS 3的18%,PI-RADS 4的46%,PI-RADS 5的85%).
- 在PI-RADS 3病变的男性中,综合策略显示了更高的csPCa检测趋势 (17.9%vs15.4%),但增加了nsPCa检测 (21.0%vs15.4%).
结论:
- 用SBx补充TBx可以改善csPCa的检测,特别是对于更高的PI-RADS得分.
- 在患有模两可 (PI-RADS 3) 病变的男性中,联合方法可能会导致nsPCa.的过度检测.
- 识别PI-RADS 3,低PSA密度或低斯德哥尔摩3测试分数的男性可能有助于避免不必要的活检.
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