从跨直肠系统转换为跨关节损伤聚焦前列腺活检:现实世界的比较分析
Thibaut Long Depaquit1, Federica Sordelli1, Christopher Agüero1
1Department of Urology, Nord Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13005 Marseille, France.
Cancers
|January 28, 2026
概括
与跨直肠 (TR) 系统活检相比,转直肠 (TP) 病变专注活检方法显著改善了临床显著前列腺癌 (csPCa) 的检测. 这种方法还可以减少低度前列腺癌的过度诊断.
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:
- 跨关节 (TP) 前列腺活检比跨直肠 (TR) 方法提供了更好的安全性.
- 针对TP病变的活检对临床显著前列腺癌 (csPCa) 检测的诊断影响,特别是使用现代策略,需要进一步评估.
- 从系统的TR过渡到以TP病变为中心的活检策略需要现实世界的评估.
研究的目的:
- 评估从基于TR的系统活检转向以TP病变为重点的方法的现实世界诊断影响.
- 为了比较两种活检策略之间的csPCa和低级癌症的检测率.
主要方法:
- 对接受图像指导前列腺活检 (2018-2025) 的男性进行了一项回顾性单中心研究,其中有一次MRI可见的病变 (PI-RADS ≥3).
- 对TR系统活检 (TR-SBx) 与使用向和周周细胞核的TP病变专注活检 (TP-LFx) 的比较.
- 治疗权重的反向概率 (IPTW) 和根据基线差异调整的双倍稳健模型.
主要成果:
- 与TR-SBx相比,TP-LFx与显著更高的csPCa检测相关 (调整OR2.52,p=0.002).
- TP-LFx显示格里森等级1组癌症的检测率较低 (OR 0.50,p=0.03),表明过度诊断的减少.
- 对TP-LFx的更强的关联观察到患者之前有负面活检和前部/上部病变.
结论:
- 在临床实践中转向以TP病变为重点的活检方法可以提高csPCa的检测.
- 专注于TP病变的策略有效地减少了低度前列腺癌的过度诊断.
- 这些发现支持采用以TP病变为重点的MRI导向活检用于当代前列腺癌诊断.
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