文章：

前列腺癌磁共振/超声融合活检中达到癌症检测基准：来自经验丰富泌尿科医师的回顾性分析启示

Meeting Cancer Detection Benchmarks in MRI/Ultrasound Fusion Biopsy for Prostate Cancer: Insights from a Retrospective Analysis of Experienced Urologists

原文发布日期：16 January 2025

DOI: 10.3390/cancers17020277

类型: Article

开放获取: 是

英文摘要：

Background: The relationship between case volume and clinical outcomes is well established for most urological procedures but remains underexplored in prostate ultrasound/MRI fusion biopsy (UMFB). UMFB aims to detect clinically significant prostate cancer (csPCa) by adhering to cancer detection benchmarks for PI-RADS lesions identified via multiparametric MRI (mpMRI). These benchmarks, defined by Ahmed et al., include cumulative cancer detection rate (C-CDR) targets of >80% for PI-RADS 5, >50% for PI-RADS 4, and <20% for PI-RADS 1–3. Methods: This retrospective, single-center study analyzed the case volumes required for two experienced urologists (U1 and U2, each with >15 years of practice) to consistently achieve the Ahmed-defined C-CDR benchmarks for csPCa (ISUP grade ≥ 2) using UMFB. Both transrectal and transperineal approaches were included to enable comprehensive learning curve analysis. Data from 2017 to 2023 were reviewed, encompassing 157 UMFBs performed by U1 and 242 by U2, with a transrectal-to-perineal ratio of 7:3. Results: Both urologists achieved Ahmed-defined C-CDR targets from the outset. Over a median follow-up of 30 months, patients with initial PI-RADS 4 or 5 ratings and negative primary biopsies remained prostate cancer-free in 77% of cases for U1 and 91.2% for U2 (p= 0.152). Conclusions: This study demonstrates that experienced urologists can achieve high diagnostic accuracy and maintain patient safety immediately upon implementing UMFB, meeting established benchmarks without requiring additional procedural learning.

摘要翻译： 

背景：对于大多数泌尿外科手术而言，病例量与临床结局之间的关系已得到充分证实，但在前列腺超声/MRI融合活检（UMFB）领域仍缺乏深入探讨。UMFB旨在通过遵循针对多参数MRI（mpMRI）识别的PI-RADS病灶设定的癌症检出基准，检测具有临床意义的前列腺癌（csPCa）。这些由Ahmed等人定义的基准包括：PI-RADS 5级病灶累计癌症检出率（C-CDR）目标>80%，PI-RADS 4级>50%，PI-RADS 1-3级<20%。 方法：本回顾性单中心研究分析了两位经验丰富的泌尿外科医师（U1和U2，均具有超过15年临床经验）在使用UMFB检测csPCa（ISUP分级≥2级）时，为持续达到Ahmed定义的C-CDR基准所需的病例量。研究同时纳入经直肠和经会阴两种入路方式，以实现全面的学习曲线分析。回顾2017年至2023年数据，U1完成157例UMFB，U2完成242例，经直肠与经会阴入路比例为7:3。 结果：两位泌尿外科医师从初始阶段即达到Ahmed定义的C-CDR目标。在中位30个月的随访期间，初始PI-RADS评分为4或5级且首次活检阴性的患者中，U1组77%未发现前列腺癌，U2组为91.2%（p=0.152）。 结论：本研究表明，经验丰富的泌尿外科医师在实施UMFB初期即可实现高诊断准确性并维持患者安全，无需额外手术学习过程即可达到既定基准。

原文链接：

Meeting Cancer Detection Benchmarks in MRI/Ultrasound Fusion Biopsy for Prostate Cancer: Insights from a Retrospective Analysis of Experienced Urologists