MRI-TRUS融合靶向穿刺活检和系统性穿刺活检与前列腺癌根治术后Gleason评分的一致性

Consistency of Gleason Scores Based on MRI-TRUS Fusion Targeted Biopsy and Systemic Biopsy with Those from Radical Prostatectomy

目的对比认知型多参数磁共振-经直肠超声引导(MRI-TRUS)下融合靶向前列腺穿刺、前列腺系统穿刺及两者联合穿刺组织活检与前列腺癌根治术后Gleason评分的一致性,寻找最佳穿刺方法。资料与方法回顾性分析2018年8月—2021年6月在四川大学华西医院行认知型MRI-TRUS融合靶向穿刺联合前列腺系统穿刺活检确诊为前列腺癌,并接受前列腺癌根治性切除术的57例患者,行穿刺活检术前均已完善前列腺多参数MR检查。以前列腺癌根治术后标本Gleason评分作为“金标准”,比较认知型MRI-TRUS融合靶向前列腺穿刺活检与前列腺系统穿刺活检对前列腺癌检出率的差异,分析两种穿刺方法及两者联合使用的Gleason评分与前列腺癌根治术后Gleason评分的一致性。结果前列腺系统穿刺活检阳性率为82.46%(47/57),认知型MRI-TRUS融合靶向穿刺活检阳性率为77.19%(44/57),差异无统计学意义(χ^(2)=0.49,P=0.484);两者联合后检出率提高至100.00%。11例临床显著前列腺癌仅由前列腺系统穿刺活检检出并经术后病理证实,而MRI-TRUS融合靶向穿刺活检结果为阴性或非临床显著前列腺癌。系统穿刺活检术后Gleason评分升级率明显高于联合穿刺活检(46.81%比10.53%;χ^(2)=17.24,P=0.00003)和认知型MRI-TRUS融合靶向穿刺活检(15.91%;χ^(2)=9.99,P=0.002),联合穿刺活检术后Gleason评分升级率与认知型MRI-TRUS融合靶向穿刺活检差异无统计学意义(χ^(2)=0.64,P=0.423)。结论认知型MRI-TRUS融合靶向前列腺穿刺与前列腺系统穿刺相结合的联合穿刺能提高穿刺阳性率,且其Gleason评分更贴近前列腺癌根治术后Gleason评分,综合表现优于单独的认知型MRI-TRUS融合靶向穿刺和系统穿刺。前列腺系统穿刺活检仍有其存在的价值。

Purpose To optimize preoperative biopsy strategy by evaluating the consistency of Gleason scores based on cognitive multiparametric magnetic resonance imaging-transrectal ultrasound(MRI-TRUS)fusion targeted biopsy,systematic biopsy,and the combined approach with those from radical prostatectomy in prostate cancer patients.Materials and Methods The present study retrospectively reviewed 57 consecutive patients who received pre-biopsy MRI and underwent radical prostatectomy after both cognitive MRI-TRUS fusion targeted biopsy and systematic biopsy from August 2018 to June 2021 at West China Hospital of Sichuan University.With the“gold standard”of whole-gland pathology after radical prostatectomy,we compared the whole-gland prostatectomy pathology outcome with cognitive MRI-TRUS fusion targeted biopsy,systematic biopsy,and combined biopsy pathology of prostate,as well as the detection rate among cognitive MRI-TRUS fusion targeted biopsy and systematic biopsy.Results The detection rate was 77.19%(44/57)in cognitive magnetic resonance imaging/transrectal ultrasound(MRI-TRUS)fusion targeted biopsy versus 82.46%(47/57)in systematic biopsy(χ^(2)=0.49,P=0.484),and the combined biopsy increased the detection rate to 100.00%.Eleven cases of clinically significant prostate cancer were detected only by systemic biopsy and eventually confirmed by whole-gland pathology after radical prostatectomy,whereas MRI-TRUS fusion targeted biopsy was negative or clinically insignificant prostate cancer.The histopathology upgrading rate of systematic biopsy was significantly higher than cognitive MRI-TRUS fusion targeted biopsy(46.81%vs.15.91%;χ^(2)=9.99,P=0.002)and the combined biopsy(10.53%;χ^(2)=17.24,P=0.00003),and there was no significant difference in terms of histopathology upgrading between cognitive MRI-TRUS fusion targeted biopsy and the combined biopsy(χ^(2)=0.64,P=0.423).Conclusion Combined biopsy provides a better diagnostic accuracy than both systematic biopsy and MRI-TRUS fusion targeted biopsy alone.Systematic biopsy still has its place in the diagnosis of prostate cancer.