靶向穿刺+6针系统穿刺对PI-RADS 5分患者的前列腺癌诊断效能

doi:10.19723/j.issn.1671-167X.2023.05.006

摘要/Abstract

摘要：

目的: 比较前列腺靶向穿刺、系统穿刺、靶向穿刺+6针系统穿刺活检对前列腺影像报告和数据系统(prostate imaging reporting and data system，PI-RADS)5分患者的前列腺癌(prostate cancer，PCa)及临床有意义前列腺癌(clinically significant prostate cancer，csPCa)的诊断效能，以优化前列腺穿刺方案。方法: 回顾性分析2019年1月至2022年6月北京大学第一医院多参数磁共振(multiparametric magnetic resonance imaging，mpMRI)检查PI-RADS评分5分且行前列腺穿刺活检的患者资料。所有患者在mpMRI/经直肠超声(transrectal ultrasound，TRUS)认知融合引导下，行联合穿刺活检(靶向穿刺联合系统穿刺)。以联合穿刺活检病理结果作为金标准，对比靶向穿刺、系统穿刺及靶向穿刺+6针系统穿刺对PCa和csPCa的诊断效能。按mpMRI T分期(cT2，cT3，cT4)进行分组，通过McNemar及Cochran’s Q检验比较不同穿刺方案对PCa和csPCa的检出情况。结果: 入组585例患者，联合穿刺阳性560例(95.7%)，阴性25例(4.3%)。mpMRI T分期cT2期233例(39.8%)，cT3期214例(36.6%)，cT4期138例(23.6%)。按临床T分期分层后发现，cT2、cT3、cT4亚组中靶向穿刺与联合穿刺对PCa、csPCa检出率差异无统计学意义(PCa：P=0.203、P=0.250、P＞0.999；csPCa：P=0.700、P=0.250、P＞0.999)，靶向穿刺+6针系统穿刺与联合穿刺对PCa、csPCa检出率差异亦无统计学意义(P均＞0.999)。系统穿刺PCa和csPCa漏诊率分别为2.1%(12/560)和1.8%(10/549)，靶向穿刺分别为1.8%(10/560)和1.4%(8/549)，而靶向穿刺+6针系统穿刺检出了所有的PCa和csPCa。但与联合穿刺相比，靶向穿刺和靶向穿刺+6针系统穿刺的平均穿刺针数更少(P＜0.001)，单针阳性率更高(P＜0.001)。结论: 对于PI-RADS 5分患者，靶向穿刺及靶向穿刺+6针系统穿刺有较高的单针阳性率及PCa、csPCa检出率，可作为前列腺穿刺方案的选择之一。

关键词: 前列腺肿瘤, 活组织检查, 磁共振成像, 前列腺影像报告和数据系统

Abstract:

Objective: To investigate the diagnostic efficacy of targeted biopsy (TBx), systematic biopsy (SBx), TBx+6-core SBx in prostate cancer (PCa) / clinically significant prostate cancer (cs-PCa) for patients with prostate imaging reporting and data system (PI-RADS) score of 5, and thereby to explore an optimal sampling scheme. Methods: The data of 585 patients who underwent multiparametric magnetic resonance imaging (mpMRI) with at least one lesion of PI-RADS score 5 at Peking University First Hospital from January 2019 to June 2022 were retrospectively analyzed. All patients underwent mpMRI / transrectal ultrasound (TRUS) cognitive guided biopsy (TBx+SBx). With the pathological results of combined biopsy as the gold standard, we compared the diagnostic efficacy of TBx only, SBx only, and TBx+6-core SBx for PCa/csPCa. The patients were grouped according to mpMRI T-stage (cT2, cT3, cT4) and the detection rates of different biopsy schemes for PCa/csPCa were compared using Cochran's Q and McNemar tests. Results: Among 585 patients with a PI-RADS score of 5, 560 (95.7%) were positive and 25(4.3%) were negative via TBx+SBx. After stratified according to mpMRI T-stage, 233 patients (39.8%) were found in cT2 stage, 214 patients (36.6%) in cT3 stage, and 138 patients (23.6%) in cT4 stage. There was no statistically significant difference in the detection rate of PCa/csPCa between TBx+6-core SBx and TBx+SBx (all P>0.999). Also, there was no statistically significant difference in the detection rate of PCa/csPCa between TBx and TBx+SBx in the cT2, cT3, and cT4 subgroups (PCa: P=0.203, P=0.250, P>0.999; csPCa: P=0.700, P=0.250, P>0.999). The missed diagnosis rate of SBx for PCa and csPCa was 2.1% (12/560) and 1.8% (10/549), and that of TBx for PCa and csPCa was 1.8% (10/560) and 1.4% (8/549), respectively. However, the detection rate of TBx+6-core SBx for PCa and csPCa was 100%. Compared with TBx+SBx, TBx and TBx+6-core SBx had a fewer number of cores and a higher detection rate per core (P < 0.001). Conclusion: For patients with a PI-RADS score of 5, TBx and TBx+6-core SBx showed the same PCa/csPCa detection rates and a high detection rates per core as that of TBx+SBx, which can be considered as an optimal scheme for prostate biopsy.

Key words: Prostatic neoplasms, Biopsy, Magnetic resonance imaging, Prostate imaging reporting and data system

中图分类号:

R737.25

刘毅,袁昌巍,吴静云,沈棋,肖江喜,赵峥,王霄英,李学松,何志嵩,周利群. 靶向穿刺+6针系统穿刺对PI-RADS 5分患者的前列腺癌诊断效能[J]. 北京大学学报（医学版）, 2023, 55(5): 812-817.

Yi LIU,Chang-wei YUAN,Jing-yun WU,Qi SHEN,Jiang-xi XIAO,Zheng ZHAO,Xiao-ying WANG,Xue-song LI,Zhi-song HE,Li-qun ZHOU. Diagnostic efficacy of prostate cancer using targeted biopsy with 6-core systematic biopsy for patients with PI-RADS 5[J]. Journal of Peking University (Health Sciences), 2023, 55(5): 812-817.

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参考文献 10

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8	Aminsharifi A , Gupta RT , Tsivian E , et al. Reduced core targeted (RCT) biopsy: Combining multiparametric magnetic resonance imaging-transrectal ultrasound fusion targeted biopsy with laterally-directed sextant biopsies: An alternative template for prostate fusion biopsy[J]. Eur J Radiol, 2019, 110, 7- 13. doi: 10.1016/j.ejrad.2018.11.006
9	Teraoka S , Honda M , Shimizu R , et al. Optimal number of systematic biopsy cores used in magnetic resonance imaging/transrectal ultrasound fusion targeted prostate biopsy[J]. Yonago Acta Med, 2021, 64 (3): 260- 268. doi: 10.33160/yam.2021.08.004
10	Sigle A , Suarez-Ibarrola R , Benndorf M , et al. Individualized decision making in transperineal prostate biopsy: Should all men undergo an additional systematic biopsy?[J]. Cancers (Basel), 2022, 14 (21): 5230. doi: 10.3390/cancers14215230

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mpMRI protocol	TR/TE	FOV	Matrix	Slice thickness/Gap	Flip angle
T2WI	3 200 ms/85 ms	240 mm×240 mm	320×256	4 mm/0 mm	90°
DWI	3 000 ms/60 ms	240 mm×240 mm	96×96	4 mm/0 mm	90°
DCE	5.0 ms/1.7 ms	240 mm×192 mm	192×128	3 mm/0 mm	15°

Items	Total (n=585)	cT2 (n=233)	cT3 (n=214)	cT4 (n=138)	P
Age/years	70 (64, 76)	69 (64, 75)	71 (65, 77)	70 (65, 76)	0.068
tPSA/(ng/mL)	25.4 (13.0, 73.6)	15.8 (10.3, 25.0)	35.5 (15.4, 80.5)	88.8 (31.7, 199.5)	＜0.001
PV/mL	49 (36, 70)	41 (30, 55)	47 (36, 65)	70 (55, 95)	＜0.001
PSAD/(ng/mL²)	0.57 (0.30, 1.30)	0.39 (0.23, 0.65)	0.74 (0.36, 1.52)	1.20 (0.46, 3.16)	＜0.001
D_max/cm	2.6 (1.9, 3.6)	2.0 (1.6, 2.4)	2.8 (2.0, 3.5)	4.0 (3.0, 4.9)	＜0.001
Zone					＜0.001
PZ only	161 (27.5)	78 (33.5)	71 (33.2)	12 (8.7)
TZ only	75 (12.8)	65 (27.9)	6 (2.8)	4 (2.9)
PZ+TZ	349 (59.7)	90 (38.6)	137 (64.0)	122 (88.4)
PCa	560 (95.7)	217 (93.1)	207 (96.7)	136 (98.6)	0.003
csPCa	549 (93.8)	208 (89.3)	206 (96.3)	135 (97.8)	0.001

Items	TBx	SBx	TBx+SBx	TBx+6-core SBx	P
Number of biopsy cores, median (Q₁, Q₃)	2 (2, 2)	10 (8, 12)	12(10, 14)	8(8, 8)	＜0.001
Number of positive cores, median (Q₁, Q₃)	2 (2, 2)	5 (3, 6)	8(6, 8)	6(4, 7)	＜0.001
Detection rate per core	89.7%	56.9%	63.4%	87.1%	＜0.001

Items	SEN/%	ACC/%	NPV/%	AUC (95%CI)	P value	Kappa
cT2 (n=233)
PCa (n=217)
TBx	97.2	97.4	72.7	0.986 (0.973-1.000)	0.203	0.828
SBx	95.4	95.7	61.5	0.977 (0.959-0.995)	0.002	0.740
TBx+6-core SBx	100.0	100.0	100.0	1.000 (1.000-1.000)	＞0.999	1.000
csPCa (n=208)
TBx	98.1	98.3	86.2	0.990 (0.979-1.000)	0.700	0.916
SBx	95.7	96.1	73.5	0.978 (0.961-0.995)	0.004	0.826
TBx+6-core SBx	100.0	100.0	100.0	1.000 (1.000-1.000)	＞0.999	1.000
cT3 (n=214)
PCa (n=207)
TBx	98.6	98.6	70.0	0.993 (0.983-1.000)	0.250	0.816
SBx	99.5	99.5	87.5	0.998 (0.992-1.000)	＞0.999	0.931
TBx+6-core SBx	100.0	100.0	100.0	1.000 (1.000-1.000)	＞0.999	1.000
csPCa (n=206)
TBx	98.5	99.5	99.2	0.993 (0.983-1.000)	0.250	0.835
SBx	99.5	99.8	99.7	0.998 (0.992-1.000)	＞0.999	0.939
TBx+6-core SBx	100.0	100.0	100.0	1.000 (1.000-1.000)	＞0.999	1.000
cT4 (n=138)
PCa (n=136)
TBx	99.3	99.3	66.7	0.996 (0.987-1.000)	＞0.999	0.796
SBx	99.3	99.3	66.7	0.996 (0.987-1.000)	＞0.999	0.796
TBx+6-core SBx	100.0	100.0	100.0	1.000 (1.000-1.000)	＞0.999	1.000
csPCa (n=135)
TBx	99.3	99.3	75.0	0.996 (0.987-1.000)	＞0.999	0.854
SBx	100.0	100.0	100.0	1.000 (1.000-1.000)	＞0.999	1.000
TBx+6-core SBx	100.0	100.0	100.0	1.000 (1.000-1.000)	＞0.999	1.000