文章：

靶向与系统性活检检测临床显著性前列腺癌的诊断准确性研究——兼论部分省略系统性活检的模型

A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies

原文发布日期：13 September 2023

DOI: 10.3390/cancers15184543

类型: Article

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英文摘要：

The primary objective of this study was to analyse the current accuracy of targeted and systematic prostate biopsies in detecting csPCa. A secondary objective was to determine whether there are factors predicting the finding of csPCa in targeted biopsies and, if so, to explore the utility of a predictive model for csPCa detection only in targeted biopsies. We analysed 2122 men with suspected PCa, serum PSA > 3 ng/mL, and/or a suspicious digital rectal examination (DRE), who underwent targeted and systematic biopsies between 2021 and 2022. CsPCa (grade group 2 or higher) was detected in 1026 men (48.4%). Discrepancies in csPCa detection in targeted and systematic biopsies were observed in 49.6%, with 13.9% of csPCa cases being detected only in systematic biopsies and 35.7% only in targeted biopsies. A predictive model for csPCa detection only in targeted biopsies was developed from the independent predictors age (years), prostate volume (mL), PI-RADS score (3 to 5), mpMRI Tesla (1.5 vs. 3.0), TRUS-MRI fusion image technique (cognitive vs. software), and prostate biopsy route (transrectal vs. transperineal). The csPCa discrimination ability of targeted biopsies showed an AUC of 0.741 (95% CI 0.721–0.762). The avoidance rate of systematic prostate biopsies went from 0.5% without missing csPCa to 18.3% missing 4.6% of csPCa cases. We conclude that the csPCa diagnostic accuracy of targeted biopsies is higher than that of systematic biopsies. However, a significant rate of csPCa remains detected only in systematic biopsies. A predictive model for the partial omission of systematic biopsies was developed.

摘要翻译： 

本研究的主要目的是分析当前靶向与系统前列腺活检在检测临床显著性前列腺癌（csPCa）方面的准确性。次要目标是确定是否存在可预测靶向活检中csPCa检出率的因素，并在此基础上探索仅基于靶向活检的csPCa预测模型的临床应用价值。我们分析了2122例疑似前列腺癌患者（血清PSA > 3 ng/mL和/或直肠指检可疑），这些患者在2021年至2022年间接受了靶向及系统活检。其中1026例（48.4%）检出csPCa（分级分组≥2级）。靶向与系统活检在csPCa检出方面存在49.6%的差异：13.9%的csPCa病例仅通过系统活检检出，35.7%仅通过靶向活检检出。基于独立预测因子——年龄（岁）、前列腺体积（mL）、PI-RADS评分（3-5分）、多参数磁共振场强（1.5T vs. 3.0T）、TRUS-MRI融合成像技术（认知融合 vs. 软件融合）及前列腺穿刺路径（经直肠 vs. 经会阴），我们构建了仅通过靶向活检检测csPCa的预测模型。靶向活检对csPCa的鉴别能力曲线下面积（AUC）为0.741（95% CI 0.721–0.762）。若完全不遗漏csPCa病例，系统活检的避免率仅为0.5%；若接受遗漏4.6%的csPCa病例，系统活检避免率可提升至18.3%。结论：靶向活检对csPCa的诊断准确性高于系统活检，但仍有相当比例的csPCa仅通过系统活检检出。本研究建立的预测模型可为选择性省略系统活检提供参考依据。

原文链接：

A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies