Since the optimal scheme for targeted biopsies of magnetic resonance imaging (MRI) suspicious lesions remains unclear, we compare the efficacy of two schemes for these index lesions. A prospective trial was conducted in 1161 men with Prostate Imaging Reporting and Data System v 2.1 3–5 undergoing targeted and 12-core systematic biopsy in four centers between 2021 and 2023. Two- to four-core MRI-transrectal ultrasound fusion-targeted biopsies via the transperineal route were conducted in 900 men in three centers, while a mapping per 0.5 mm core method (saturated scheme) was employed in 261 men biopsied in another center. A propensity-matched 261 paired cases were selected for avoiding confounders other than the targeted biopsy scheme. CsPCa (grade group ≥ 2) was identified in 125 index lesions (41.1%) when the two- to four-core scheme was employed, while in 187 (71.9%) when the saturated biopsy (p< 0.001) was used. Insignificant PCa (iPCa) was detected in 18 and 11.1%, respectively (p= 0.019). Rates of csPCa and iPCa remained similar in systematic biopsies. CsPCa detected only in systematic biopsies were 5 and 1.5%, respectively (p= 0.035) in each group. The saturated scheme for targeted biopsies detected more csPCa and less iPCa than did the two- to four-core scheme in the index lesions. The rate of csPCa detected only in the systematic biopsies decreased when the saturated scheme was employed.
鉴于磁共振成像（MRI）可疑病灶靶向活检的最佳方案尚不明确，本研究比较了两种针对此类指标病灶的活检方案效能。2021年至2023年间，我们在四个中心对1161例前列腺影像报告和数据系统v2.1评分为3-5级的男性患者进行了前瞻性试验，实施靶向活检联合12针系统活检。其中三个中心的900例患者采用经会阴途径的2-4针MRI-经直肠超声融合靶向活检方案，另一中心的261例患者则采用每0.5毫米间隔穿刺的饱和活检方案。为排除靶向活检方案外的混杂因素，研究通过倾向性匹配筛选出261对病例进行分析。结果显示：采用2-4针方案时，125处指标病灶（41.1%）检出具有临床意义的前列腺癌（csPCa，分级分组≥2级）；而采用饱和活检方案时，187处指标病灶（71.9%）检出csPCa（p<0.001）。非显著前列腺癌（iPCa）检出率分别为18%和11.1%（p=0.019）。两种方案在系统活检中检出的csPCa和iPCa比例保持相近。仅在系统活检中检出的csPCa比例分别为5%和1.5%（p=0.035）。研究表明：针对指标病灶，饱和靶向活检方案较2-4针方案能检出更多csPCa和更少iPCa；采用饱和方案时，仅通过系统活检检出的csPCa比例显著降低。
肿瘤(癌症)患者之家