认知融合及影像融合在前列腺穿刺活检中的应用

Evaluation of cognitive fusion and image fusion in prostate biopsy: a retrospective cohort study

目的:探讨多参数磁共振(mpMRI)图像引导下,认知融合及影像融合的前列腺靶向穿刺活检术及传统系统性穿刺活检术对前列腺癌检出能力的对比。方法:回顾性收集2017年8月1日~2019年3月31日我院mpMRI提示前列腺癌的初次穿刺活检患者,按照所行的靶向穿刺方法分为认知融合组(COG组)及影像融合组(FUS组),两组分别行认知融合靶向穿刺(COG-TB)及影像融合靶向穿刺(FUS-TB)后,再行常规系统性穿刺活检(TRUS-SB)。对比两组组内与组间靶向穿刺及系统性穿刺的结果。对于行前列腺根治性切除术(RP)的患者,以根治标本作为金标准与两组穿刺结果进行对比。结果:COG组纳入78例患者,FUS组纳入24例患者,比较COG组、FUS组的靶向穿刺及系统性穿刺发现,COG组COG-TB vs.COG组TRUS-SB vs.FUS组FUS-TB vs.FUS组TRUS-SB的前列腺癌检出率(60.3%vs.61.5%vs.58.3%vs.62.5%,P=0.99),有临床意义前列腺癌检出率(55.1%vs.55.1%vs.58.3%vs.58.3%,P=0.97)、Gleason评分[(7.8±1.1)vs.(7.6±0.8)vs.(7.7±1.1)vs.(7.6±1.0),P=0.93]及ISUP分级[(3.5±1.2)vs.(3.4±1.3)vs.(3.5±1.0)vs.(3.3±1.3),P=0.97]比较差异均无统计学意义。以根治标本作为金标准,COG组COG-TB vs.TRUS-SB vs.RP的Gleason评分[(7.5±1.0)vs.(7.4±1.0)vs.(7.6±1.2),P=0.73]及ISUP分级[(3.1±1.1)vs.(3.1±1.3)vs.(3.4±1.4),P=0.66]比较差异无统计学意义,FUS组FUS-TB vs.TRUS-SB vs.RP的Gleason评分[(7.6±0.8)vs.(7.6±1.0)vs.(7.6±0.9),P=0.98]及ISUP分级[(3.5±1.0)vs.(3.4±1.2)vs.(3.6±0.9),P=0.92]比较差异亦无统计学意义。结论:在前列腺初次穿刺活检患者中,认知融合、影像融合及常规系统性穿刺对前列腺癌的检出率、有临床意义前列腺癌的检出率无明显差异,以根治标本作为金标准,靶向融合未明显低估前列腺癌的Gleason评分及ISUP分级。mpMRI影像引导下的靶向穿刺是临床有效、可行的穿刺方式。

Objective: Cognitive fusion and image fusion are two main methods of multiparametric magnetic resonance imaging(mpMRI)-guided targeted prostate biopsy. A retrospective study is conducted to evaluate the efficacy of cognitive fusion, image fusion and systematic biopsy on detecting prostate cancer. Method: Patients who were mpMRI positive of prostate cancer without prior biopsy from Aug 1st, 2017 to March 31st, 2019 were enrolled in this study. Patients underwent cognitive fusion(COG-TB) with concurrent systematic biopsy(TRUS-SB) and image fusion(FUS-TB) with concurrent TRUS-SB were grouped into COG and FUS group respectively. Detection rate of prostate cancer, clinically significant prostate cancer, Gleason score and ISUP grade were studied. Data from patients underwent radical prostectomy(RP) were also analyzed and radical samples were used as gold standard. Result: Seventy-eight patients underwent COG-TB+TRUS-SB and were fitted into COG group. Twenty-four patients underwent FUS-TB+TRUS-SB and were fitted into FUS group. Detection rate of prostate cancer in COG-TB vs concurrent TRUS-SB vs. FUS-TB vs concurrent TRUS-SB was 60.3% vs. 61.5% vs. 58.3% vs. 62.5%, P=0.99. No significant difference was found. Detection rate of clinically significant prostate cancer(55.1% vs. 55.1% vs. 58.3% vs. 58.3%, P=0.97), Gleason score [(7.8±1.1) vs.(7.6±0.8) vs.(7.7±1.1) vs.(7.6±1.0), P=0.93], ISUP grade [(3.5±1.2) vs.(3.4±1.3) vs.(3.5±1.0) vs.(3.3±1.3), P=0.97] were also comparable among biopsy methods stated above. In patients underwent RP, no significant differences were found in Gleason score of COG-TB vs. concurrent TRUS-SB vs. RP [(7.5±1.0) vs.(7.4±1.0) vs.(7.6±1.2), P=0.73] and in ISUP grade [(3.1±1.1) vs.(3.1±1.3) vs.(3.4±1.4), P=0.66]. Gleason score [(7.6±0.8) vs.(7.6±1.0) vs.(7.6±0.9), P=0.98] and ISUP grade [(3.5±1.0) vs.(3.4±1.2) vs.(3.6±0.9), P=0.92 ] of FUS-TB vs concurrent TRUS-SB vs RP were also comparable. Conclusion: No significant differences were found among COG-TB, FUS-TB and concurrent TRUS-SB in detection rate of prostate cancer, detection rate of clinically significant prostate cancer, Gleason score and ISUP grade. No significant differences of Gleason score and ISUP grade were found among COG-TB, TRUS-SB and RP specimen or among FUS-TB, TRUS-SB and RP specimen. Our conclusion shows both COG-TB and FUS-TB are feasible in biopsy-na■ve patients.