文章：

大型教学医院中基于双参数磁共振成像及磁共振靶向活检的前列腺癌诊断路径效果评估

Outcomes of a Diagnostic Pathway for Prostate Cancer Based on Biparametric MRI and MRI-Targeted Biopsy Only in a Large Teaching Hospital

原文发布日期：29 September 2023

DOI: 10.3390/cancers15194800

类型: Article

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英文摘要：

Background: Diagnostic pathways for prostate cancer (PCa) balance detection rates and burden. MRI impacts biopsy indication and strategy. Methods: A prospectively collected cohort database (N = 496) of men referred for elevated PSA and/or abnormal DRE was analyzed. All underwent biparametric MRI (3 Tesla scanner) and ERSPC prostate risk-calculator. Indication for biopsy was PIRADS ≥ 3 or risk-calculator ≥ 20%. Both targeted (cognitive-fusion) and systematic cores were combined. A hypothetical full-MRI-based pathway was retrospectively studied, omitting systematic biopsies in: (1) PIRADS 1–2 but risk-calculator ≥ 20%, (2) PIRADS ≥ 3, receiving targeted biopsy-cores only. Results: Significant PCa (GG ≥ 2) was detected in 120 (24%) men. Omission of systematic cores in cases with PIRADS 1–2 but risk-calculator ≥ 20%, would result in 34% less biopsy indication, not-detecting 7% significant tumors. Omission of systematic cores in PIRADS ≥ 3, only performing targeted biopsies, would result in a decrease of 75% cores per procedure, not detecting 9% significant tumors. Diagnosis of insignificant PCa dropped by 52%. PCa undetected by targeted cores only, were ipsilateral to MRI-index lesions in 67%. Conclusions: A biparametric MRI-guided PCa diagnostic pathway would have missed one out of six cases with significant PCa, but would have considerably reduced the number of biopsy procedures, cores, and insignificant PCa. Further refinement or follow-up may identify initially undetected cases. Center-specific data on the performance of the diagnostic pathway is required.

摘要翻译： 

背景：前列腺癌（PCa）的诊断路径需在检出率与检查负担之间取得平衡。磁共振成像（MRI）对活检指征及策略具有重要影响。方法：本研究对一项前瞻性收集的队列数据库（N=496）进行分析，该数据库纳入因前列腺特异性抗原（PSA）升高和/或直肠指检（DRE）异常而转诊的男性患者。所有患者均接受双参数MRI（3特斯拉扫描仪）检查及欧洲前列腺癌随机筛查研究（ERSPC）前列腺风险计算器评估。活检指征设定为前列腺影像报告和数据系统（PIRADS）评分≥3分或风险计算器评估值≥20%。活检采用认知融合靶向穿刺与系统穿刺相结合的方式。研究通过回顾性分析模拟了基于完整MRI的诊断路径，在以下两种情况下省略系统穿刺：（1）PIRADS 1-2分但风险计算器评估值≥20%；（2）PIRADS≥3分仅接受靶向穿刺。结果：在120例（24%）男性患者中检出有临床意义的前列腺癌（Gleason评分≥2）。对于PIRADS 1-2分但风险计算器评估值≥20%的病例，若省略系统穿刺将使活检指征减少34%，但会导致7%的有临床意义肿瘤漏诊。对于PIRADS≥3分的病例，若仅进行靶向穿刺而省略系统穿刺，将使单次操作穿刺针数减少75%，但会导致9%的有临床意义肿瘤漏诊。无临床意义前列腺癌的诊断率下降52%。仅通过靶向穿刺未能检出的前列腺癌中，67%位于MRI靶病灶同侧。结论：双参数MRI引导的前列腺癌诊断路径可能导致六分之一有临床意义前列腺癌病例漏诊，但能显著减少活检操作次数、穿刺针数及无临床意义前列腺癌的检出。通过路径优化或随访可能识别初始未检出的病例。诊断路径的实施效果需结合各医疗中心的具体数据进行分析。

原文链接：

Outcomes of a Diagnostic Pathway for Prostate Cancer Based on Biparametric MRI and MRI-Targeted Biopsy Only in a Large Teaching Hospital