磁共振实时引导与认知融合穿刺活检术对前列腺特异性抗原<20μg/L患者前列腺癌检出率的比较研究

Comparative study on prostate cancer detection rates of MRI-guided in-bore biopsy versus cognitive fusion biopsy for patients with prostate specific antigen levels<20μg/L

目的比较磁共振实时引导穿刺(MRI-BX)与认知融合穿刺(COG-BX)靶向活检术对前列腺特异性抗原(PSA)<20μg/L患者前列腺癌检出率的差异。方法回顾性研究,连续入选2015年1月至2018年12月北京医院195例PSA<20μg/L行前列腺穿刺活检患者的临床资料,其中MRI-BX组80例,COG-BX组115例,比较两组患者年龄、PSA、前列腺体积、PSA密度(PSAD)、前列腺影像报告和数据系统(PI-RADS)评分等临床资料,分析穿刺结果中前列腺癌及临床有意义前列腺癌的检出率。结果MRI-BX组与COG-BX组患者比较,年龄、PSA、前列腺体积、PSAD、PI-RADS评分差异无统计学意义(均P>0.05);MRI-BX组和COG-BX组前列腺癌总体检出率分别为53.8%(43/80)和50.4%(58/115),差异无统计学意义(P=0.649);其中临床有意义前列腺癌分别占58.1%(25/43)和82.8%(48/58),差异有统计学意义(P=0.006)。在PSA<10μg/L的患者中,MRI-BX组和COG-BX组前列腺癌总体检出率分别为45.2%(28/62)和48.0%(36/75),差异无统计学意义(P=0.740);其中临床有意义前列腺癌占50.0%(14/28)和91.7%(33/36),差异有统计学意义(P=0.001)。结论在PSA<20μg/L且MRI提示可疑病灶(PI-RADS3分)的患者中,MRI-BX和COG-BX对前列腺癌的总体检出率无差异,但COG-BX对临床有意义前列腺癌的检出率更高,特别是PSA<10μg/L患者优势更为明显。

Objective To compare the differences in prostate cancer detection rate between MRI-guided in-bore biopsy(MRI-BX)and cognitive fusion biopsy(COG-BX)in patients with prostate specific antigen(PSA)levels<20μg/L.Methods From January 2015 to December 2018,clinical data of 195 patients with PSA levels<20μg/L were consecutively included in this retrospective study.Of these patients,80 underwent MRI-BX procedures and 115 underwent COG-BX procedures.Clinical data including age,PSA,prostate volume,PSA density(PSAD),Prostate Imaging Reporting and Data System(PI-RADS)scores,overall prostate cancer detection rate and detection rate of clinically significant prostate cancer were compared and analyzed.Results There was no significant difference in age,PSA,prostate volume,PSAD and PI-RADS scores between the two groups.There was no significant difference in total prostate cancer detection rate between the MRI-BX and COG-BX groups(53.8%or 43/80 vs.50.4%or 58/115,P=0.649),while the detection rates for clinically significant prostate cancer showed a significant difference between the two groups(58.1%or 25/43 vs.82.8%or 48/58,P=0.006).There was no significant difference in prostate cancer detection rate between the MRI-BX and COG-BX groups in patients with PSA<10μg/L(45.2%or 28/62 vs.48.0%or 36/75,P=0.740),while a significant difference was found in the detection rate of clinically significant prostate cancer between the two groups in patients with PSA<10μg/L(50.0%or 14/28 or 91.7%or 33/36,P=0.001).Conclusions The overall prostate cancer detection rate does no differ between MRI-BX and COG-BX in patients with PSA levels<20μg/L or with suspicious MRI lesions(PI-RADS3),but the COG-BX procedure has a higher detection rate than the MRI-BX procedure for clinically significant prostate cancer,especially in patients with PSA<10μg/L.