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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (5): 812-817. doi: 10.19723/j.issn.1671-167X.2023.05.006

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Diagnostic efficacy of prostate cancer using targeted biopsy with 6-core systematic biopsy for patients with PI-RADS 5

Yi LIU1,Chang-wei YUAN1,Jing-yun WU2,Qi SHEN1,Jiang-xi XIAO2,*(),Zheng ZHAO1,*(),Xiao-ying WANG2,Xue-song LI1,Zhi-song HE1,Li-qun ZHOU1   

  1. 1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
    2. Department of Radiology, Peking University First Hospital, Beijing 100034, China
  • Received:2023-03-13 Online:2023-10-18 Published:2023-10-09
  • Contact: Jiang-xi XIAO,Zheng ZHAO E-mail:cjr.xiaojiangxi@vip.163.com;zzpkufh@163.com
  • Supported by:
    the Scientific Research Seed Fund of Peking University First Hospital(2020SF24)

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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

CLC Number: 

  • R737.25

Table 1

mpMRI acquisition parameters"

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°

Figure 1

Several prostate biopsy sampling schemes SBx, systematic biopsy; TBx, targeted biopsy."

Table 2

Clinical characteristics of PI-RADS 5 patients"

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
Dmax/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

Figure 2

Detection of PCa using several prostate biopsy sampling schemes TBx, targeted biopsy; SBx, systematic biopsy; nPCa, non-prostate can-cer; csPCa, clinically significant prostate cancer; cisPCa, clinically insignificant prostate cancer."

Table 3

Number of cores using different prostate biopsy sampling schemes"

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

Table 4

Diagnostic efficacy of PCa and csPCa using several prostate biopsy sampling schemes for cT2-cT4 patients"

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
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